Antibodies

 

Self-Limited Autoimmune Syndrome Rare in Infliximab-Treated Patients ---------------------------------------------------------------------------- ----

 WESTPORT, CT (Reuters Health) Dec 15, 2000 - The anti-tumor necrosis factor monoclonal antibody infliximab, used to treat rheumatoid arthritis, can induce antibodies to double-stranded DNA, but the risk of developing a reversible lupus syndrome is small, according to a report published in the November issue of Arthritis and Rheumatism. 

Dr. R. N. Maini, from The Kennedy Institute of Rheumatology, in London, and colleagues compared the incidence of anti-double stranded DNA (anti-dsDNA) antibodies occurring in 156 rheumatoid arthritis (RA) patients treated with infliximab and 37 patients treated with placebo. In a previous open-label study, the investigators reported that 2 of 20 patients treated with infliximab developed anti-dsDNA antibodies. "In the subsequent trials that are included in this report, we have observed this phenomenon in a further 20 patients," the authors note. 

However, "only one of these patients showed clinical symptoms suggestive of a drug-induced lupus syndrome." The condition resolved within 8 weeks with oral prednisolone therapy. This patient developed anti-dsDNA IgG, IgM, and IgA antibodies, the researchers report. All other patients who developed anti-dsDNA antibodies manifested only IgM class antibodies. "The lack of clinical disease in all but one patient is notable and may be related to the isotype of the anti-dsDNA produced, since it has been suggested that only IgG class anti-dsDNA antibodies are pathogenic," the authors point out. 

"Data emerging from a larger study of 428 patients suggest that the frequency of induced anti-dsDNA antibodies is similar to the frequency we report here and that the frequency of infliximab-induced lupus is even less, since only 1 other such RA patient has been reported," the investigators note. "Given the benefit of infliximab therapy in the treatment of methotrexate-resistant RA," 

Dr. Maini's group concludes that "the risk of a self-limiting autoimmune syndrome appears to be small and not a significant limitation to its use in clinical practice." Arthritis Rheum 2000;43:2383-2390.

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