Oter-López B, Llamas-Velasco M, Sánchez-Pérez J, Dauden E
Servicio de Dermatología, Hospital Universitario de la Princesa, Madrid, España.
Servicio de Dermatología, Hospital Universitario de la Princesa, Madrid, España.
Actas Dermosifiliogr. 2017 Jun;108(5):445-456. doi: 10.1016/j.ad.2016.12.014. Epub 2017 Mar 6.
The induction of antinuclear antibodies (ANA) and the onset of autoimmune diseases have been reported after treatment with tumor necrosis factor (TNF) inhibitors, though controversy persists.
To determine the frequency of onset of autoimmune diseases and of the appearance of autoantibodies in psoriasis patients administered TNF inhibitors (adalimumab and etanercept) subcutaneously and to correlate this with the effectiveness of treatment, adverse effects, and the order of use of TNF inhibitors. We also tried to identify any factors that might predict the appearance of ANA and autimmune diseases.
We performed a retrospective study of a cohort of 121 patients monitored over an 11-year period. ANA were measured at baseline and at 3, 6, and 12 months; positive results were followed up by study of antibodies to double-stranded DNA. Extractable nuclear antigen (ENA) antibodies were also studied at baseline and at 3, 6, and 12 months. Patients with a baseline assay of ANA and ENA at least one more assay during the first year were included in the study, and these antibodies were measured annually thereafter. Psoriasis area severity index was calculated and adverse effects were recorded at each visit.
A significant increase in ANA positivity was observed during treatment of moderate-to-severe psoriasis with adalimumab and etanercept, but this was not associated with the onset of autoimmune diseases. No correlation was observed with treatment efficacy, the order of use of TNF inhibitors, or the appearance of adverse effects. No predictive factors for the appearance of ANA were identified, except for the body mass index.
We recommend ANA measurement and screening for autoimmune diseases prior to treatment with TNF inhibitors, but not routine serial measurements of ANA during follow-up except in patients with signs or symptoms suggestive of autoimmune disease.
尽管仍存在争议，但有报道称使用肿瘤坏死因子（TNF）抑制剂治疗后会诱导产生抗核抗体（ANA）并引发自身免疫性疾病。
确定皮下注射TNF抑制剂（阿达木单抗和依那西普）的银屑病患者中自身免疫性疾病的发病频率和自身抗体的出现情况，并将其与治疗效果、不良反应以及TNF抑制剂的使用顺序相关联。我们还试图找出可能预测ANA和自身免疫性疾病出现的任何因素。
我们对一组121例患者进行了为期11年的回顾性研究。在基线以及第3、6和12个月时检测ANA；对阳性结果通过研究双链DNA抗体进行随访。在基线以及第3、6和12个月时还研究了可提取核抗原（ENA）抗体。在第一年中至少进行过一次ANA和ENA基线检测的患者被纳入研究，此后每年检测这些抗体。计算银屑病面积严重程度指数，并在每次就诊时记录不良反应。
在用阿达木单抗和依那西普治疗中度至重度银屑病期间，观察到ANA阳性率显著增加，但这与自身免疫性疾病的发病无关。未观察到与治疗效果、TNF抑制剂的使用顺序或不良反应的出现之间存在相关性。除体重指数外，未发现ANA出现的预测因素。
我们建议在使用TNF抑制剂治疗前检测ANA并筛查自身免疫性疾病，但在随访期间除有提示自身免疫性疾病的体征或症状的患者外，不建议常规连续检测ANA。
Zotero 插件