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P480 Characteristics of drug-induced lupus 2° to anti-TNF agents in inflammatory bowel disease patients and evolution after switch to a second anti-TNF

Mañosa M.*1, Corrales G.1, Olivares D.2, Vicuña M.3, Aguas M.4, Busquets D.5, Tosca J.6, Llaό J.7, Mesonero F.8, García-Tejero I.9, Ferreiro R.10, Cabré E.1, Domènech E.1

1Hospital Universitari Germans Trias i Pujol and CIBERehd, Gastroenterology, Badalona, Spain 2H Clínico San Carlos, Gastroenterology, Madrid, Spain 3Complejo Hospitalario de Navarra, Gastroenterolgy, Pamplona, Spain 4Hospital La Fe, Gastroenterology, Valencia, Spain 5Hospital universitari de Girona. Dr Trueta, Gastroenterology, Girona, Spain 6Hospital Clínic de Valencia, Gastroenterology, Valencia, Spain 7Hospital Santa Creu i Sant Pau, Gastroenterology, Barcelona, Spain 8H Ramon y Cajal, Gastroenterology, Madrid, Spain 9H Santa Lucia, Gastroenterology, Cartagena, Spain 10Hospital Universitario de Santiago, Gastroenterology, Santiago de Compostela, Spain

Background

Anti-TNF agents can induce the formation of antinuclear antibodies (ANA), anti-DNA, and can facilitate the development of drug-induced lupus (DILE). DILE treatment could require anti-TNF withdrawal and use of steroids, antimalarials and immunosuppressants to control DILE symptoms. Little is known if it is a class effect or drug dependent, and there is no information about the safety of switching to another anti-TNF.

Objectives: To describe the characteristics of DILE due to anti-TNF in patients with inflammatory bowel disease (IBD) and evaluate their progress after switch to another anti-TNF.

Methods

A retrospective, multicenter descriptive study. We identified all cases of DILE from the participating centres, which meet with the following criteria: 1) temporal relationship between the administration of anti-TNF and the development of symptoms and autoantiboides and 2) at least 4 systemic lupus criteria or the presence of nephritis in the presence of ANA or anti-DNAds. Evolution was recorded in case of beginning a second anti-TNF.

Results

We identified 38 patients with DILE due to anti-TNF (76% women, 73% Crohn's disease and 27% ulcerative colitis) with a mean age of 38 (±11) years at the time of DILE. The mean time under treatment with anti-TNF to DILE diagnosis was 14 (±12) months. Regarding anti-TNF agents, 70% cases of DILE were associated with IFX and 30% with adalimumab, 66% of patients were concomitant treated with IMS and 34% with mesalazine. Most common feature of DILE were: arthritis (91%), rash (64%), oral ulcers (20%). Serologically, 91% ANA+, 20% anti DNAds+, 9% low levels complement. Anti-TNF agents was retired in 94% of cases and 77% required specific treatment (14% hydroxychloroquine, steroids 43%, methotrexate 17%). 60% of patients started a second anti-TNF, with recurrence of symptoms in 21% of them.

Conclusion

DILE secondary to anti-TNF is a rare phenomenon that requires specific treatment in most cases despite the withdrawal of the anti-TNF. Switching to another anti-TNF is seldom associated with the recurrence of DILE.