RESEARCH - SLE induced by anti-TNF therapy

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Systemic lupus erythematosus induced by anti-tumour necrosis factor alpha

therapy: a French national survey

Michel De Bandt1, Sibilia2, Xavier Le Loët3, Sebastian Prouzeau4, Bruno

Fautrel5, Christian Marcelli6, Boucquillard7, Louis Siame8 and

Xavier Mariette9 for the Club Rhumatismes et Inflammation

1Rheumatology Department, Hôpital Ballanger, Aulnay sous Bois, France

2CHU Hautepierre, Strasbourg, France

3Hôpital Bois-Guillaume, Rouen, France

4Hôpital de Saint Lo, Saint Lo, France

5Hôpital Pitié Salpétrière, Assistance Publique-Hôpitaux de Paris, Paris,

France

6CHU côte de Nacre, Caen, France

7Hôpital de Saint Pierre de la Réunion, St Pierre France

8Polyclinique de Riaumont, Liévin, France

9Hôpital de Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin

Bicêtre, France

Arthritis Research & Therapy 2005, 7:R545-R551 doi:10.1186/ar1715

Published 1 March 2005

Abstract

The development of drug-induced lupus remains a matter of concern in

patients treated with anti-tumour necrosis factor (TNF) alpha. The incidence

of such adverse effects is unknown. We undertook a retrospective national

study to analyse such patients.

Between June and October 2003, 866 rheumatology and internal medicine

practitioners from all French hospital centres prescribing anti-TNF in

rheumatic diseases registered on the website of the 'Club Rhumatismes et

Inflammation' were contacted by email to obtain the files of patients with

TNF-induced systemic lupus erythematosus. Twenty-two cases were collected,

revealing two aspects of these manifestations. Ten patients (six patients

receiving infliximab, four patients receiving etanercept) only had anti-DNA

antibodies and skin manifestations one could classify as 'limited skin

lupus' or 'toxidermia' in a context of autoimmunity, whereas 12 patients

(nine patients receiving infliximab, three patients receiving etanercept)

had more complete drug-induced lupus with systemic manifestations and at

least four American Congress of Rheumatology criteria. One patient had

central nervous system manifestations. No patients had lupus nephritis. The

signs of lupus occurred within a mean of 9 months (range 3-16 months) in

patients treated with infliximab and within a mean of 4 months (range 2-5

months) in patients treated with etanercept. In all cases after diagnosis

was determined, anti-TNF was stopped and specific treatment introduced in

eight patients: two patients received intravenous methylprednisolone, four

patients received oral steroids (15-35 mg/day), and two patients received

topical steroids. Lupus manifestations abated within a few weeks (median 8

weeks, standard deviation 3-16) in all patients except one with

longer-lasting evolution (6 months). At that time, cautious estimations

(unpublished data from Schering Plough Inc. and Wyeth Inc.) indicated that

about 7700 patients had been exposed to infliximab and 3000 to etanercept

for inflammatory arthritides in France. It thus appears that no drug was

more implicated than the other in lupus syndromes, whose incidence was

15/7700 = 0.19% with infliximab and 7/3800 = 0.18% with etanercept.

Clinicians should be aware that lupus syndromes with systemic manifestations

may occur in patients under anti-TNF alpha treatment.

http://arthritis-research.com/content/7/3/R545/abstract

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