Autoantibody formation in patients with RA treated with anti-TNF-alpha therapy

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Ann Rheum Dis. 2004 Aug 5 [Epub ahead of print]

Autoantibody formation in patients with rheumatoid arthritis treated

with anti-TNF-alpha therapy.

sson C, Engstrand S, Sundqvist KG, Rantapaa-Dahlqvist S.

Department of Clinical Immunology, University Hospital, S-901 85 Umea,

Sweden.

BACKGROUND: Contradictory results have been presented on autoantibody

formation in patients treated with TNF-a inhibitors. OBJECTIVE: To study

the prevalence of autoantibodies in patients with rheumatoid arthritis

(RA) treated with the TNF-a inhibitor, infliximab for 54 weeks.

MATERIALS AND METHODS: Fifty-three patients (48 females and 11 males)

with RA and treated with infliximab were followed for autoantibody

production before treatment and after 14, 30 and 54 weeks. For

comparison 6 patients treated with etanercept were included. The

analyses included antibodies against nuclear antigens (ANA), extractable

nuclear antigens (ENA), double stranded (ds)DNA (by ELISA, IIF on

Crithidia luciliae for IgM and IgG, and Farr assay), nucleosomes,

cardiolipin, smooth muscle, mitochondria, proteinase 3 and

myeloperoxidase antigens. RESULTS: The number of patients treated with

infliximab that developed antibodies against dsDNA both of IgG and IgM

class (tested by IIF) increased significantly. The prevalence of

positive patients for IgG class increased to 66% at 30 weeks and 45% at

54 weeks and of IgM class to 85% and 70%,respectively. Likewise, the

titre and number of patients expressing antibodies against nucleosomes

and ANA increased significantly. The number of RF or anti-cardiolipin

positive patients was stable and nor was there any increase of

antibodies against the other antigens. A lupus-like syndrome was seen in

one patient. No patient treated with etanercept developed any of the

autoantibodies.

CONCLUSION: A significant number of patients treated with infliximab

developed anti-dsDNA antibodies, of both IgM and IgG class,

anti-nucleosome antibodies and ANA with gradual increase until 30 weeks.

PMID: 15297281

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