Introduction Drug induced lupus erythematosus (DILE) due to infliximab therapy for inflammatory bowel diseases (IBD) is an uncommon occurrence. It remains uncertain whether patients with infliximab induced DILE could benefit from another anti-tumour necrosis factor (TNF) agent without recurrent DILE.
Methods We reviewed the case records of patients with infliximab induced DILE diagnosed at Massachusetts General Hospital and noted details of their clinical and immunological profile at presentation. Case notes of patients who were treated with a second anti-TNF agent were examined for evidence of recurrent DILE.
Results Thirteen patients with infliximab therapy induced DILE were identified with a female to male ratio of 11:2 (Abstract 009). Symmetric large joint arthralgias were noted in all patients; fever and malar rash were noted in 2 and 3 patients, respectively. All patients had high titers of anti-nuclear and anti-double stranded DNA antibody. Median peak ANA titer was 1 in 2560 and 7 out of 13 (53.8%) patients had a titer of 1 in 2560 or greater. Anti-histone antibodies were positive in 4/7 patients tested; human anti-chimeric antibody was negative in the two tested patients. Eight patients were retreated with a second anti-TNF agent (6 certolizumab pegol and 2 adalimumab) of whom two patients (1 adalimumab and certolizumab pegol) developed recurrent DILE. One patient self-discontinued therapy after 2 months despite no recurrence of DILE. Five patients remain well with no recurrence of DILE after a median of 5 months (range 2–6) therapy.
Conclusion Re-challenge with a further anti-TNF agent in patients who have developed DILE with infliximab is associated with a 25% recurrence rate during short-term follow-up implying that DILE may be drug specific rather than class specific, permitting ongoing treatment with an anti-TNF agent in some patients with infliximab induced DILE.
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