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Prolonged Treatment With Infliximab Causes Autoantibody Formation

Prolonged treatment with infliximab typically results in autoantibody formation, which is correlated with a greater number of infusions and a higher total dose of infliximab infused, new research suggests.

Infliximab, a monoclonal antibody to tumour necrosis factor-alpha, is used to treat a variety of inflammatory arthritic diseases. In early reports, the formation of autoantibodies was noted in a small number of patients; however, the extent of autoantibody formation and the association with treatment efficacy and adverse effects have not been fully evaluated.

Mariam Louis, MD, with the McGill University Health Centre at Montreal General Hospital, Quebec, Canada, and colleagues determined the frequency and correlates of autoantibody formation in patients with rheumatic diseases treated with infliximab in a routine clinical setting.

Forty-two patients, who had received 5 or more infusions of infliximab and who planned on continuing the medication, were prospectively evaluated for the development of antinuclear antibody (ANA), anti-DNA, anti-Sm, anti-RNP, anti-SSA and anti-SSB. The researchers assessed correlation of these autoantibody levels with pharmacologic treatments, response to infliximab, and adverse events.

Of the patients, 76% developed new autoantibodies, and these autoantibodies persisted in 57%. The most common new autoantibody was ANA in 45%, followed by anti-DNA in 33%, anti-Sm in 31%, and anti-RNP in 29%.

New autoantibody formation was associated with both a greater number of infusions (P = .015) and a higher total dose of infliximab infused (P = .047). However, no other treatment or disease characteristics or loss of efficacy to infliximab were correlated with new antibody formation, the researchers point out. Furthermore, no patient developed symptoms of a new connective tissue disease.

"We observed a high rate of new and persistent autoantibody formation in patient with rheumatic disease receiving prolonged treatment with infliximab," the researchers conclude.

"Although no patient, to date, has manifested disease characteristics that might be related to autoantibody formation, long-term follow-up and meticulous continuing care of patients undergoing prolonged treatment with infliximab is indicated," they suggest.


J Rheumatol 2003;30:2557-2562. "Induction of autoantibodies during prolonged treatment with infliximab"

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