Original paper Autoimmunogenicity during anti-TNF therapy in patients with psoriasis and psoriatic arthritis

Abstract

IntroductionThe tumor necrosis factor (TNF-α) was initially described as lymphotoxin or cachectin. The discovery of therapies blocking the action of TNF-α, in 1988, started a new era in the therapy. One of often reported adverse effects related to the use of TNF-α antagonists is induction of the formation of autologous antibodies and antibodies neutralizing anti-TNF drugs. The development of anti-TNF-induced lupus or classical drug-induced lupus is more rarely reported.AimTo evaluate the presence and the level of anti-nuclear antibodies in patients with psoriasis and psoriatic arthritis and the influence of anti-TNF therapy used on the concentration of antinuclear antibody (ANA).Material and methodsA total of 28 subjects were included in the study. 71.4% of subjects were diagnosed with psoriatic arthritis and 28.6% with plaque psoriasis.ResultsAmong the patients with plaque psoriasis, the antinuclear antibodies were found in 25% of subjects and in 80% of patients with psoriatic arthritis. After the treatment an increase in the titer or appearance of antibodies was found in 66.7% in the infliximab group, 18.2% in the etanercept group and 54.7% in the adalimumab group. No subjects developed symptoms of drug-induced systemic lupus.ConclusionsOur findings have shown that all anti-TNF therapies induced ANA in psoriatic arthritis and psoriatic patients. Considering a mild course of lupus induced by anti-TNF treatment and, usually intrinsic, resolution of symptoms, the biological therapy still appears as a safe treatment for patients.

Is there any increased risk of hypertension, diabetes and cardiac diseases in psoriatic patients with TNF-α G238A and G308A polymorphism?

“…Tumour necrosis factor α (TNF-α) is an important proinflammatory cytokine that plays a role in the pathogenesis of several diseases such as psoriasis, diabetes, cardiovascular disease and cancer [4–9]. It is located in the major histocompatibility complex III (MHC) region on chromosome 6p21.3.…”

New insight into the pathogenesis of nail psoriasis and overview of treatment strategies

“…Infections, such as mycobacterium tuberculosis, demyelinating diseases, congestive heart failure, induction of the formation of autologous antibodies, and production of antibodies neutralizing anti-TNF-α drugs were described as adverse reactions related to the anti-TNF-α agent. 64 …”

A case of lupus-like syndrome in a patient receiving adalimumab and a brief review of the literature on drug-induced lupus erythematosus

“…Anti‐dsDNA (anti‐double‐stranded DNA) antibodies as well as ENAs (extractable nuclear antibodies) and low complement levels occur more often in anti‐TNF DILE, whereas antihistone antibodies are detected more frequently in classic DILE . Patients treated with infliximab appear to develop ANA more often than patients receiving adalimumab or etanercept . Infliximab is considered to be the most immunogenic due to its chimeric structure and presumed higher tissue concentration, whereas adalimumab, a fully human monoclonal antibody targeted against TNF is thought to be the least immunogenic.…”

“…15,30 Patients treated with infliximab appear to develop ANA more often than patients receiving adalimumab or etanercept. 24,31 Infliximab is considered to be the most immunogenic due to its chimeric structure and presumed higher tissue concentration, whereas adalimumab, a fully human monoclonal antibody targeted against TNF 19 is thought to be the least immunogenic. Its structure and shorter dosing intervals may explain its apparent greater tolerability.…”