Paradoxical adverse events in inflammatory bowel disease patients taking infliximab
Keywords:
inflammatory bowel disease, infliximab, paradoxical inflammation phenomena.Abstract
Background: There are some reports of paradoxical inflammation phenomena associated with anti-TNF therapy in patients with inflammatory
bowel disease (IBD). The aim of this study has been to evaluate the
incidence of paradoxical inflammation phenomena in patients with
inflammatory bowel disease (IBD) treated with infliximab (IFX).
Methods: The authors carried out a retrospective analysis of 64
patients with IBD (55 with Crohn disease (CD) and 9 with ulcerative
colitis (UC)). They were interviewed and clinical processes reviewed in
order to identify possible adverse effects associated with this therapy.
Interim acute infusion reactions were excluded.
Results: In the 64 patients included, 38 were males with a mean
age of 39 years. In our group of patients, the major indication for
biological therapy was the presence of active disease (78.1%). The
mean duration of the treatment was 4 years (1-11). 78.1% were
taking 5 mg/Kg and the frequency of infusions was every 8 weeks in
70.3%. 20.3% of patients were treated with azathioprine and 26.6%
with aminosalicylates. We observed paradoxical inflammation events
in 21 patients. The most common changes were skin reactions (folliculitis, eczema, psoriasis), followed by arthritis/arthralgia, lupus and
auto-immune hepatitis. In 6 patients (28.6%) IFX had to be suspended
in order to solve the reaction (1 hepatitis, 2 lupus and 3 patients with
psoriasis) and specific therapy to this complication was started. The
effects were more frequent in the group of patients taking 10 mg/kg
(p=0.17) and less frequent with the concomitant use of azathioprine
(p=0.22).
Conclusions: In this study, paradoxical inflammation events were
frequent, although those requiring drug withdrawal were relatively
rare. Paradoxical inflammatory events should be treated with systemic
therapy directed to the reaction and in most cases it may lead drug
withdrawal. Once under control, it is possible restart biologic therapy
(with another anti-TNF agent or even the same in a lower dosage) to
maintain remission in IBD.
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References
Magro F; Portela F; Management of inflammatory bowel disease with infliximab and other anti-tumor necrosis factor alpha therapies, BioDrugs. 2010; 24 (Suppl 1):3-14.
Peyrin-Biroulet L, Anti-TNF therapy in inflammatory bowel diseases: a huge review, Minerva Gastroenterol Dietol. 2010; 56(2):233-243.
Iborra M, Beltrán B, Bastida G, Aguas M, Nos P, Infliximab and adalimumab-induced psoriasis in Crohn’s disease: a paradoxical side effect, J Crohns Colitis. 2011; 5(2):157-161.
Hoentjen, F, Bodegraven, A., Safety of anti-tumor necrosis factor therapy in inflammatory bowel disease, WJG, 2009 May; 15 (17): 2067-2073.
Russel et al, Anti-tumor necrosis factor therapies in Immune-Mediated Rheumatic Diseases. Other Observations from the Clinic; The Journal of Rheumatology 2010; 37: (Suppl 85); 53-62.
Cosnes J, Cattan S, Blain A et al. Long-term evolution of disease behavior of Crohn’s disease. Inflamm Bowel Dis 2002; 8:244-250.
Peyrin-Byroulet L, Ferrante M, Magro F et al. results from the 2nd Scientific Worshop of the ECCO (1): Impact of mucosal healing on the course of inflammatory bowel disease. JCC 2011; 5: 477-483.
Mantzaris GJ, Christidou A, Sfakianakis M et al. Azathioprine is superior to budesonide in achieving and maintaining mucosal healing and histologic remission in steroid-dependent Crohn’s disease. Inflamm Bowel Dis 2009; 15: 375-382.
Keating GM, Perry CM, Infliximab: an update review of its use in Crohn`s Disease and rheumatoid arthritis. BioDrugs. 2002;16(2):111-148.
Cottone M, Criscuoli V. Infliximab to treat Crohn’s disease: an update. Clin Exp Gastroenterol. 2011; 4: 227-238.
Yanai H, Hanauer SB. Assessing response and loss of response to biological therapies in IBD. Am J Gastroenterol. 2011; 106(4):685-698.
Singh JA, Wells GA, Christensen R et al. Adverse effects of biologics: a network meta-analysis and Cochrane overview. Cochrane Database Syst Rev. 2011 Feb 16;(2):CD008794.
Ramos-Casals M, Brito-Zerón P, Muñoz S et al. Autoimmune diseases induced by TNF-targeted therapies: analysis of 233 cases. Medicine (Baltimore) 2007; 86:242.
Esmailzadeh A et al. Predictive factors of eczema-like eruptions among patients without cutaneous psoriasis reciving infliximab: a cohort study of 92 patients. Dermatology 2009; 219 (3): 263-267.
Chan J, Davis-Reed L, Kimball AB. Counter-regulatory balance: atopic dermatitis in patients undergoing infliximab infusion therapy. Journal of drugs in Dermatology; May-June 2004.
Ramos-Casals M, Roberto-Perez-Alvarez, Diaz-Lagares C, Cuadrado MJ, Khamashta MA; BIOGEAS Study Group. Autoimmune diseases induced by biological agents: a double-edged sword?. Autoimmun Rev. 2010;9(3):188-193.
Wendling D, Balblanc JC, Briançon D, Brousse A, Lohse A, Deprez P, Humbert P, Aubin F. Onset or exacerbation of cutaneous psoriasis during TNFalpha antagonist therapy. Joint Bone Spine. 2008 ;75(3):315-318.
Elliott MJ, Maini RN, Feldmann M et al. Repeated therapy with monoclonal antibody to tumour necrosis factor alpha (cA2) in patients with rheumatoid arthritis. Lancet 1994; 344:1125.
Atzeni F, Turiel M, Capsoni F, Doria A, Meroni P, Sarzi-Puttini P. Autoimmunity and anti-TNF-alpha agents. Ann N Y Acad Sci. 2005;1051:559-569.
Collamer AN, Battafarano DF.Psoriatic skin lesions induced by tumor necrosis factor antagonist therapy: clinical features and possible immunopathogenesis. Semin Arthritis Rheum. 2010;40(3):233-240.
Harrison MJ, Dixon WG, Watson KD et al. Rates of new-onset psoriasis in patients with rheumatoid arthritis receiving anti-tumour necrosis factor alpha therapy: results from the British Society for Rheumatology Biologics Register.
Ann Rheum Dis 2009; 68:209.
http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/DrugSafetyInformationforHeathcareProfessionals/ucm174474.htm (Accessed on January 04, 2012).
Gannes GC, Ghoreishi M, Pope J et al. Psoriasis and pustular dermatitis triggered by TNF-{alpha} inhibitors in patients with rheumatologic conditions. Arch Dermatol 2007; 143:223.
Wetter D et al. Lupus-like syndrome attributable to anti-tumor necrosis factor α therapy in 14 patients during an 8-year period at Mayo Clinic. Mayo Clin Proc 2009; 84(11): 979-984.
De Bandt M, Sibilia J, Le Loët X, Prouzeau S, Fautrel B, Marcelli C, Boucquillard E, Siame JL, Mariette X; Club Rhumatismes et Inflammation. Systemic lupus erythematosus induced by anti-tumour necrosis factor alpha therapy: a French national survey.Arthritis Res Ther. 2005;7(3):R545-551.
Cush JJ. Unusual toxicities with TNF inhibition: heart failure and drug-induced lupus. Clin Exp Rheumatol. 2004;22(5 Suppl 35):S141-147.
Tobon g et al. Serious liver disease induced by infliximab. Clin Rheumatol 2005
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