Search in the Abstract Database

Search Abstracts 2011

* = Presenting author

P275. Non-organ specific autoantibodies (NOSA) on TNF-α antagonists: A study in 40 patients with inflammatory bowel disease (IBD)

M. Cappello, C. Randazzo, A. Licata, F. Barbaria, I. Bravatà, P.L. Almasio, A. Craxì

University of Palermo, Palermo, Italy

Aim: Anti-tumor necrosis factor (TNF) agents are effective for treatment of IBD. Despite a good overall safety profile, they can induce a number of adverse effects, including induction of NOSA, such as antinuclear antibodies (ANA) and double-stranded (ds) DNA antibodies, and eventually a lupus-like syndrome. The clinical relevance of NOSA and predictive factors related to their appearance are unclear. We aimed to evaluate their prevalence among patients with IBD treated with anti-TNF alpha agents at a tertiary referral center.

Materials and Methods: IBD patients in remission under maintenance anti-TNF alpha therapy (infliximab or adalimumab, or infliximab and adalimumab consecutively) were tested before treatment and after 24 and 54 weeks for autoantibodies production. Sera were analyzed for antibodies against nuclear antigens (ANA), smooth muscle (SMA), mitochondria (AMA), liver-kidney microsomes (LKM) and double stranded (ds-DNA) by indirect immunofluorescence. Data regarding demographic and clinical features, anti-TNF alpha treatment, concomitant immunosuppressive medication, development of autoimmune manifestations (arthralgia, lupus-like syndrome, vasculitis, psoriasis, skin rashes, autoimmune hepatitis) were recorded.

Results: Forty patients (16 males, median age 46 yrs, range 21–69) were studied. Thirty-two had Crohn's disease (CD) and 8 ulcerative colitis (UC); 18 (45.0%) were treated with infliximab, 4 (10.0%) with adalimumab and 18 (45.0%) with infliximab followed by adalimumab. Twenty-six patients received concomitant immunosuppressive medication (9 azathioprine and 17 steroids). Overall ANA positivity was observed in 22 (55.0%) subjects (16/32 in CD and 6/8 with UC, p ns), SMA positivity in 5 (12.5%) and only one AMA positivity. Among ANA positive patients 2 showed anti-ds-DNA positive autoantibodies. ANA positivity was detected in 13 out of 18 (72.2%) patients treated with infliximab, 9 out of 18 (50.0%) with infliximab plus adalimumab and in none in 4 patients treated with adalimumab alone (p = 0.027). Concomitant immunosuppressive therapy had no influence on ANA positivity development. None of these patients experienced an overt lupus-like syndrome. Four subjects developed peripheral poli-articular arthralgia involving mainly small joints after a mean period of 6.0±11.2 months. All patients had NOSA. Symptoms have required paracetamol and/or low doses of steroids. Biological therapy was not withdrawn, except in a single patient with ANA and AMA positivity who developed also a skin rash.

Conclusions: NOSA are produced in a fairly high proportion of patients with IBD on anti-TNF therapy. They appear more frequently in infliximab-treated patients as compared to those who received adalimumab alone. NOSA were rarely associated with clinical features of autoimmunity and, when occurring, did not dictate discontinuation of anti-TNF therapy.