Divisione di Dermatologia, Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Ospedale S. Orsola-Malpighi, Università di Bologna, Bologna, Italy.
J Dtsch Dermatol Ges. 2014 May;12(5):401-6. doi: 10.1111/ddg.12339.
TNF-α inhibitors have been associated with induction of autoantibodies and autoimmune diseases. We retrospectively evaluated the incidence of autoantibodies ANA, ENA, anti-dsDNA, the occurrence of clinical symptoms and possibly related treatment failure.
The titers of ANA, ENA and anti-dsDNA were evaluated from blood samples every six months in 128 patients receiving a TNF-α inhibitor (adalimumab, etanercept, infliximab).
Overall 37% of 128 patients treated with anti-TNF-α drug developed autoantibodies, mostly induced by infliximab; 48.48 % of patients who received infliximab presented autoantibodies. One patient developed a drug-induced lupus erythematosus. Forty-five patients were switched to one or more additional TNF-α inhibitors and 25 developed autoantibodies.
An increased autoantibody titer is not predictive of treatment failure; particular attention to all phenomena suggestive for autoimmunity is needed in patients with a positive autoantibody titer. Further studies are needed to clarify the role of autoantibodies during anti-TNF- α therapy.
TNF-α 抑制剂与自身抗体的产生和自身免疫性疾病有关。我们回顾性评估了自身抗体 ANA、ENA、抗 dsDNA 的发生率、临床症状的发生和可能相关的治疗失败。
128 例接受 TNF-α 抑制剂（阿达木单抗、依那西普、英夫利昔单抗）治疗的患者每 6 个月采集一次血样，评估 ANA、ENA 和抗 dsDNA 的滴度。
128 例接受抗 TNF-α 药物治疗的患者中，总体有 37%产生了自身抗体，主要由英夫利昔单抗诱导；接受英夫利昔单抗的患者中，48.48%出现了自身抗体。1 例患者发生药物诱导性红斑狼疮。45 例患者转为一种或多种额外的 TNF-α 抑制剂，其中 25 例产生了自身抗体。
自身抗体滴度的升高并不能预测治疗失败；对于自身抗体滴度阳性的患者，需要特别注意所有提示自身免疫的现象。需要进一步研究来阐明自身抗体在抗 TNF-α 治疗中的作用。
