Anti‐TNF‐induced lupus in patients with inflammatory bowel disease. Issue 3 (19th December 2019)

• Record Type: Journal Article
• Authors: Picardo, Sherman; So, Kenji; Venugopal, Kannan
• Is Part Of: JGH open. Volume 4:Issue 3(2020)
• Page Start: 507
• Page End: 510
• Publication Date: 2019-12-19
• Subjects: adalimumab -- anti‐tumor necrosis factor -- anti‐TNF‐induced lupus -- inflammatory bowel disease -- infliximab -- lupus
• DOI: 10.1002/jgh3.12291
• Languages: English
• ISSNs: 2397-9070

Abstract

Abstract : Background and Aims: Anti‐Tumor Necrosis Factor (TNF)‐induced lupus (ATIL) is a distinct clinical entity, increasingly recognized in patients with inflammatory bowel disease treated with anti‐TNF therapy. Our aims were to evaluate the incidence and clinical and serological markers of ATIL in this population. Methods: This observational cohort study reviewed 454 patient treatment courses with anti‐TNF therapy (300 infliximab and 154 adalimumab). A diagnosis of ATIL was based on the most widely accepted diagnostic criteria: (i) a temporal relationship between symptoms and anti‐TNF therapy and resolution of symptoms following cessation of the offending medication; (ii) at least one serologic American College of Rheumatology (ACR) criterion of Systemic Lupus Erythematosus (SLE); and (iii) at least one nonserological criterion such as arthritis, serositis, or rash. Clinical, demographic, and serological predictors were evaluated. Results: The incidence rate of ATIL was 5.7% for infliximab and 0.6% for adalimumab, which are much higher than previously reported postmarketing estimates. The median duration to diagnosis following commencement of anti‐TNF therapy was 15 months (3–62 months). ATIL occurs more commonly patients that commence therapy at an older age (46.47 years ± 13.79 years vs. 38.85 years ± 14.75 years, P = 0.033). Conclusions: ATIL is a significant complication of anti‐TNF therapy, affecting 1 in every 20 patients who commence infliximab. A panel of serological markers is useful to confirm the diagnosis and exclude other conditions that may mimic ATIL. Clinicians using anti‐TNF medications should counsel patients about this potential risk and monitor for clinical manifestations of lupus during routine follow up. Abstract : This is a retrospective study that looks at anti‐TNF‐induced lupus, a distinct clinical entity increasingly identified in patients with inflammatory bowel disease on anti‐TNF therapy. ATIL occurs more commonly than previously reported and is more common in those who commence therapy at an older age. The combination of clinical symptoms, the temporal relationship to anti‐TNF therapy, and a panel of serological markers can assist clinicians in confirming a diagnosis.