Etanercept/infliximab for antiphospholipid syndrome

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From Medscape's " Ask the Experts " - a little old, but still relevant.

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Etanercept/Infliximab for Antiphospholipid Syndrome

Question

Is there a role for etanercept/infliximab treatment in the

antiphospholipid syndrome?

Response from J. Cush, MD

Clinical Professor of Internal Medicine, University of Texas

Southwestern Medical School at Dallas; Chief, Rheumatology and Clinical

Immunology, Presbyterian Hospital of Dallas, Texas

Both etanercept and infliximab are newly approved by the Food and Drug

Administration. They are inhibitors of circulating and cell bound tumor

necrosis factor (TNF)-alpha and are indicated in the treatment of

inflammatory disorders such as rheumatoid arthritis and Crohn's disease.

Their use in other inflammatory and other autoimmune diseases is being

defined. It appears, however, that these agents should not be used in

patients with lupus (or lupus-like disorders) because they may

exacerbate lupus symptoms and are known to induce double-stranded DNA

(dsDNA) antibodies, especially infliximab. The mechanisms by which TNF

inhibition may lead to worsening of systemic lupus erythematosus and the

formation of dsDNA antibodies is unknown. There are no trials or

anecdotal reports of etanercept or infliximab use in patients with

antiphospholipid syndrome. Moreover, I am unaware of any research that

would implicate TNF as playing a pathogenic role in this coagulopathy.

Lastly, there is a report in the French literature that suggests that

thalidomide therapy (a weak TNF inhibitor) may induce thrombotic events

in lupus patients who have risk factors for thromboses (eg,

anticardiolipin antibodies) but have never had a thrombotic event.[1]

Posted 09/13/2000

http://www.medscape.com/viewarticle/414007

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org