|Title||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.|
|Publication Type||Journal Article|
|Year of Publication||2011|
|Authors||Verma HDev, Scherl EJanice, Jacob VElizabeth, Bosworth BPaul|
|Journal||J Dig Dis|
|Date Published||2011 Oct|
|Keywords||Adult, 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|
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.
|Alternate Journal||J Dig Dis|