Journal Article

Lupus-Like Syndrome Attributable to Anti—Tumor Necrosis Factor α Therapy in 14 Patients During an 8-Year Period at Mayo Clinic

Wetter, David A., Davis, Mark D.P.

2009

Overview

To examine clinical characteristics, laboratory features, and outcomes of patients with lupus-like syndrome attributable to anti—tumor necrosis factor α (TNF-α) therapy. We performed a retrospective review of patients with lupus-like syndrome attributable to anti—TNF-α therapy at Mayo Clinic's site in Rochester, MN, between July 1, 2000, and June 30, 2008. Of 14 patients (mean age at disease onset, 46.2 years), 12 (86%) were female. Ten patients (71%) had Crohn disease, and 4 (29%) had rheumatoid arthritis. Thirteen patients (93%) originally were treated with infliximab, and 1 (7%) was treated with adalimumab. A lupus-ike syndrome occurred after a mean treatment duration of 16.2 months. Features of lupus included presence of antinuclear antibodies (14 patients [100%]), arthritis (13 patients [93%]), anti—double-stranded-DNA antibodies (10 patients [71%]), cutaneous findings (malar rash, discoid rash, or photosensitivity, 4 patients [29%]), serositis (4 patients [29%]), hematologic abnormalities (4 patients [29%]), oral ulcers (4 patients [29%]), and lupus anticoagulant (1 patient [7%]). No patient had renal or neurologic abnormalities. All patients improved after stopping anti—TNF-α therapy (mean time to improvement, 2.9 months). Four (80%) of 5 patients tolerated an alternative TNF-α inhibitor (adalimumab, 3 patients; etanercept, 1 patient) without recurrence of lupus-like syndrome. Compared with previous studies, cutaneous findings were less frequent and arthritis was more frequent in our cohort of patients. Some patients were able to tolerate an alternative TNF-α inhibitor without recurrence of lupus-like syndrome.

• Publisher: Elsevier Inc
• Subject: Academic Medical Centers / Age Distribution / Antibodies, Monoclonal - adverse effects / Antibodies, Monoclonal - therapeutic use / Crohn Disease - diagnosis / Crohn Disease - drug therapy / Dose-Response Relationship, Drug / Drug Administration Schedule / Female / Follow-Up Studies / Humans / Incidence / Infliximab / Infusions, Intravenous / Internal Medicine / Lupus Erythematosus, Systemic - chemically induced / Lupus Erythematosus, Systemic - epidemiology / Lupus Erythematosus, Systemic - physiopathology / Male / Middle Aged / Minnesota / Retrospective Studies / Risk Assessment / Sampling Studies / Sex Distribution / Syndrome / Time Factors / Tumor Necrosis Factor-alpha - antagonists & inhibitors