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Anti-nuclear antibody positivity and the use of certolizumab in inflammatory bowel disease patients who have had arthralgias or lupus-like reactions from infliximab or adalimumab.

TitleAnti-nuclear antibody positivity and the use of certolizumab in inflammatory bowel disease patients who have had arthralgias or lupus-like reactions from infliximab or adalimumab.
Publication TypeJournal Article
Year of Publication2011
AuthorsVerma HDev, Scherl EJanice, Jacob VElizabeth, Bosworth BPaul
JournalJ Dig Dis
Volume12
Issue5
Pagination379-83
Date Published2011 Oct
ISSN1751-2980
KeywordsAdult, Antibodies, Antinuclear, Antibodies, Monoclonal, Antibodies, Monoclonal, Humanized, Arthralgia, Female, Humans, Immunoglobulin Fab Fragments, Inflammatory Bowel Diseases, Lupus Erythematosus, Systemic, Male, Middle Aged, Polyethylene Glycols, Retrospective Studies, Tumor Necrosis Factor-alpha
Abstract

OBJECTIVE: Tumor necrosis factor (TNF) inhibitors can be used to treat inflammatory bowel disease (IBD) but may lead to anti-nuclear antibody (ANA) positivity and lupus-like reactions. Because of its unique structure, certolizumab has lower rates of these complications. We sought to investigate whether patients who have had lupus-like reactions to infliximab or adalimumab would be able to tolerate certolizumab.

METHODS: We performed a retrospective analysis on the 23 patients at the Roberts Inflammatory Bowel Disease Center who received certolizumab for the treatment of Crohn's disease from March 2008 to June 2009. We identified 6 patients who were switched to this drug because of lupus-like reactions from prior anti-TNF therapy and had documented ANA after the reaction and prior to certolizumab initiation. We then rechecked the ANA status after certolizumab initiation.

RESULTS: Five out of 6 patients had a resolution of their arthralgias or lupus-like symptoms after being switched to certolizumab (P < 0.001). Of the 4 patients who were ANA positive after receiving infliximab or adalimumab, 2 became ANA negative after induction with certolizumab (P = 0.17). There was no difference in Harvey Bradshaw index scores (10.3 vs. 9.8) pre-certolizumab and post-certolizumab (P = 0.73).

CONCLUSION: Nearly all patients experienced relief from their lupus-like symptoms with certolizumab and 2 out of 4 patients reversed their ANA positivity. While future investigation is warranted, patients who have lupus-like reactions from infliximab or adalimumab may benefit from switching to certolizumab.

DOI10.1111/j.1751-2980.2011.00522.x
Alternate JournalJ Dig Dis
PubMed ID21955431