Anti-nuclear antibody positivity and the use of certolizumab in inflammatory bowel disease patients who have had arthralgias or lupus-like reactions from infliximab or adalimumab

Abstract

Objective: Tumor necrosis factor (TNF) inhibitors can be used to treat inflammatory bowel disease (IBD) but may lead to anti-nuclear antibody (ANA) positivity and lupus-like reactions. Because of its unique structure, certolizumab has lower rates of these complications. We sought to investigate whether patients who have had lupus-like reactions to infliximab or adalimumab would be able to tolerate certolizumab. Methods: We performed a retrospective analysis on the 23 patients at the Roberts Inflammatory Bowel Disease Center who received certolizumab for the treatment of Crohn's disease from March 2008 to June 2009. We identified 6 patients who were switched to this drug because of lupus-like reactions from prior anti-TNF therapy and had documented ANA after the reaction and prior to certolizumab initiation. We then rechecked the ANA status after certolizumab initiation. RESULTS: Five out of 6 patients had a resolution of their arthralgias or lupus-like symptoms after being switched to certolizumab (P<0.001). Of the 4 patients who were ANA positive after receiving infliximab or adalimumab, 2 became ANA negative after induction with certolizumab (P=0.17). There was no difference in Harvey Bradshaw index scores (10.3 vs. 9.8) pre-certolizumab and post-certolizumab (P=0.73). Conclusion: Nearly all patients experienced relief from their lupus-like symptoms with certolizumab and 2 out of 4 patients reversed their ANA positivity. While future investigation is warranted, patients who have lupus-like reactions from infliximab or adalimumab may benefit from switching to certolizumab. © 2011 The Authors. Journal of Digestive Diseases © 2011 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and Blackwell Publishing Asia Pty Ltd.