Possible Association of Etanercept, Venous Thrombosis, and Induction of Antiphospholipid Syndrome

Abstract

Tumor necrosis factor α (TNF α) inhibitors are commonly used for treatment of aggressive rheumatoid arthritis and other rheumatic diseases. Etanercept is one of the medications approved for treatment of rheumatoid arthritis. Though many studies have documented the safety and efficacy of these medications, evidence for adverse effects is emerging including cancer, infections, and cardiovascular disease. There have been studies showing that these medications induce autoantibody production, including antinuclear antibodies and anti-dsDNA antibodies. Limited data exists, however, regarding induction of antiphospholipid antibodies (APLs) by TNF α inhibitors, including anticardiolipin antibodies (ACLs), lupus anticoagulant (LAC), and anti-β 2-glycoprotein I (anti-β 2 GPI), or an association between antibody development and clinical manifestations. In this case series, we describe five patients who developed venous thromboembolism (VTE) and APLs while receiving etanercept therapy. All five of our patients met the criteria for diagnosis of APS after receiving etanercept. Our case series supports the association between etanercept, APLs, and VTE. We believe that testing for APLs prior to initiation of anti-TNF therapy is reasonable, given this relationship and the risks associated with VTE.

Emerging Risk Biomarkers in Cardiovascular Diseases and Disorders

“…Atrial fibrillation (AF) is a very common tachyarrhythmia and is becoming increasingly prevalent venous thrombosis. Besides stroke, altered cerebral blood flow in AF and cerebral microbleeds from anticoagulation may enhance the risk of dementia [ 59 ]. More often, levels of microRNAs play emerging roles in adipogenesis and obesity [ 60 ] while P255Galectin-3 was found to be a new promising cardiac biomarker in sports endurance [ 181 ].…”

Thromboembolic event associated with antitumor necrosis factor‐alpha treatment: report of a case

“…Other factors have been involved in promoting this state as inflammatory disease itself, a longer disease duration and a resistance to previous treatments (Tables and ). A prudent measure could be the evaluation of serological markers for antiphospholipid syndrome, such as lupus anticoagulant, anticardiolipin antibody, and anti‐ β 2‐glycoprotein antibodies, before the administration of an anti‐TNF‐ α . Published cases of severe TE such as necrosis of several toes, portal vein thrombosis, retinal thrombosis, or left ventricular thrombus are rare but should not be forgotten .…”

Thrombosis in Autoimmune Diseases: A Role for Immunosuppressive Treatments?

“…Moreover, antiphospholipid antibodies have been found during anti-TNF-α therapy and sometimes are associated with the development of APS. [117][118][119][120][121] Disease-Modifying Antirheumatic Drugs DMARDS are extensively used in different autoimmune rheumatic diseases, such as SLE and RA among them. Despite the different mechanisms of action, these drugs can reduce systemic inflammation.…”