Drug Insight: autoimmune effects of medications—what's new?

Abstract

Autoantibodies and lupus-like syndromes can develop following the use of certain medications; however, although many patients develop autoantibodies, only a minority develop clinical features. Although these autoantibodies primarily consist of antinuclear and antihistone antibodies, additional types of antibody, such as antineutrophil cytoplasmic antibodies and anti-double-stranded DNA antibodies, have been reported in association with minocycline and tumor necrosis factor inhibitor therapy. Clinical features of drug-related lupus usually consist of constitutional symptoms, arthralgias, arthritis, myalgias and serositis, although cutaneous manifestations have been reported in association with the use of tumor necrosis factor inhibitors. Typically, clinical features resolve with discontinuation of the medication, although antibodies can persist for months or years. Arthralgias and inflammatory arthritis have also been reported in association with the use of aromatase inhibitors and other biologic agents such as interleukins and interferons.

A role for muscarinic receptors in neutrophil extracellular trap formation and levamisole-induced autoimmunity

“…Unlike these idiopathic autoimmune syndromes, which often require potent immunosuppressive therapies to achieve disease remission, symptoms of levamisole-induced autoimmunity typically resolve with cessation of the offending agent, emphasizing the need to recognize and understand the mechanisms underlying this unique clinical syndrome (10).…”

Vasculitis Associated With Tumor Necrosis Factor-α Inhibitors

“…1,2 However, along with increasing use of these agents in clinical practice have come secondary autoimmune conditions paradoxically induced by anti-TNF-␣ therapy. [3][4][5][6][7] The induction of vasculitis after the use of TNF-␣ inhibitors has been reported in the French-and Spanish-language medical literature. [8][9][10][11] To our knowledge, there is no single-center series in the English-language medical literature describing the development of vasculitis attributable to TNF-␣ antagonist therapy in patients in the United States.…”

Anti-TNF tedavi ile ilişkili lupus like sendromu

“…Anti-TNF kullanan hastalarda lupus-like sendromu prevalansı %0.5-1 bulunmuşken infliksimab kullanan hastalarda %0.19 olarak bulunmuştur (13,14). Diğer yandan romatoid artrit nedeniyle anti-TNF kullanan hastalarda lupus-like sendromu oranı %0.1-0.6 iken, Crohnlu hastalarda %1.6 olarak raporlanmıştır (15). Ancak, ilaca bağlı lupusta genellikle ateş, artralji, miyalji, artrit, serozit ve deri döküntüleri oluşur.…”