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Impact of Three Anti-TNFα Biologics on Existing and Emergent Autoimmunity in Rheumatoid Arthritis and Spondylarthropathy Patients

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Abstract

Objective

The objective of this study was to analyze the effects of 3 anti-TNFα agents on markers of autoimmunity in rheumatoid arthritis (RA) and spondylarthropathy (SPA) patients.

Methods

First-time anti-TNFα biologics (infliximab, etanercept, or adalimumab) were prescribed to 156 RA and 95 SPA (58 ankylosing spondylarthritides, 37 psoriatic arthritides). During 1–2 years of follow-up, clinical, biological [antinuclear (ANA) and anti-double-stranded (dsDNA) antibodies, rheumatoid factors (RF), and anti-cyclic citrullinated peptide (CCP) for RA], and therapeutic data were collected biannually.

Results

ANA appeared or ANA and anti-dsDNA titers increased significantly (P < 0.001) more under infliximab than etanercept in both rheumatisms and than adalimumab in RA patients. During the 2-year follow-up, ANA appeared more in RA patients taking adalimumab than etanercept (P = 0.003), but independently of the anti-TNFα used; anti-dsDNA titers rarely became positive. Under etanercept or infliximab, ANA and anti-dsDNA were not influenced by the underlying pathology nor were they affected by infliximab intensification over 18 months. Only one case of cutaneous lupus was observed in a patient having IgG anti-dsDNA. The therapeutic responses were independent of ANA and anti-dsDNA titers for all rheumatisms and biologics. In RA patients, RF titers, but not anti-CCP levels, declined with the therapeutic response for all biologics.

Conclusion

This is the first study that has evaluated the impact of three TNFα blockers on ANA and anti-dsDNA antibodies in RA and SPA patients. Autoimmunity was more induced with infliximab than etanercept and to a lesser degree to adalimumab but, more importantly, this emergent autoimmunity was exceptionally associated to clinical manifestations of lupus.

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Abbreviations

RA:

rheumatoid arthritis

SPA:

spondylarthropathy

ANA:

antinuclear

RF:

rheumatoid factor

Anti-CCP:

anti-cyclic citrullinated peptide

TNFα:

tumor necrosis factor alpha

AutoAb:

autoantibodies

Anti-ds DNA:

anti-double-stranded DNA

ANCA:

antineutrophil cytoplasm

MTX:

methotrexate

DAS 28:

disease activity score 28

ACR:

American College of Rheumatology

BASDAI:

Bath ankylosing spondylitis disease activity index

BASFI:

Bath ankylosing spondylitis functional index

ESR:

erythrocyte sedimentation rate

CRP:

C-reactive protein

IFN:

interferon

MAb:

monoclonal antibody

Il:

interleukin

HACA:

human anti-chimeric antibodies

Etan:

etanercept

Adal:

adalimumab

Infl:

infliximab

NS:

non-significant

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Acknowledgments

The authors thank Janet Jacobson for editorial assistance.

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Authors and Affiliations

  1. Department of Rheumatology, Rouen University Hospital & Inserm U905 (IFRMP 23), Institute for Biomedical Research, University of Rouen, 76031, Rouen Cedex, France

    H. Bacquet-Deschryver, V. Goëb, T. Lequerré, O. Mejjad, A. Daragon, X. Le Loët & O. Vittecoq

  2. Laboratory of Immunology & Inserm U905 (IFRMP 23), Institute for Biomedical Research, University of Rouen, Rouen, France

    F. Jouen & F. Tron

  3. Laboratory of Biochemistry, Rouen University Hospital, Rouen, France

    M. Quillard

  4. Department of Biometry–Biostatistics, Rouen University Hospital, Rouen, France

    J. F. Ménard

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  1. H. Bacquet-Deschryver
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Correspondence to O. Vittecoq.

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Bacquet-Deschryver, H., Jouen, F., Quillard, M. et al. Impact of Three Anti-TNFα Biologics on Existing and Emergent Autoimmunity in Rheumatoid Arthritis and Spondylarthropathy Patients. J Clin Immunol 28, 445–455 (2008). https://doi.org/10.1007/s10875-008-9214-3

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  • DOI: https://doi.org/10.1007/s10875-008-9214-3

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