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The Incidence and Predictors of Lupus-like Reaction in Patients with IBD Treated with Anti-TNF Therapies

Yanai, Henit MD*,†; Shuster, Dmitry MD; Calabrese, Emma MD, PhD§; Mlynarsky, Liat MD*,†; Tumuluri, Srilaxmi MD; Cohen, Russell D. MD

doi: 10.1097/01.MIB.0000435435.91988.b6
Original Clinical Articles

Background: The incidence of lupus-like reactions (LLRs) in patients with inflammatory bowel disease (IBD) treated with anti-tumor necrosis factor (ATNF) has not been well defined. We aimed to characterize the features and predictors associated with LLR.

Methods: We studied a cohort of adult patients with IBD treated with ATNF by a single specialist during 2009. Patients with LLR were characterized and compared with those without LLR for possible predictors.

Results: Twenty of 289 patients (6.9%) had LLR (19.9 cases per 1000 patient-years). Female gender and IBD-unclassified were more prevalent in the LLR group (85% versus 54%, P = 0.009; and 15% versus 2.2%, P = 0.018, respectively), with a hazard ratio of 3.89 (95% confidence interval = 1.12–13.55; P = 0.033) and 7.38 (95% confidence interval = 1.93–28.23; P = 0.003), respectively. ATNF duration was shorter in the LLR group (median, 1 year [interquartile range, 0–3] versus 3 years [interquartile range, 1–6.5], P = 0.005). Arthropathy was universal, followed by fatigue and dermatitis (30% each). Antinuclear antibodies were universally positive, and 16 of 20 had anti–double-stranded DNA. ATNF was discontinued in all; 8 patients required corticosteroids and 1 required hydroxychloroquine followed by complete clinical resolution (mean 7.9 ± 5.9 months). Antinuclear antibodies reverted or normalized in 7 of 16 patients (44%). Fourteen patients (70%) were switched to a second ATNF, 2 with concomitant immunomodulators, and 12 as monotherapy. One patient on ATNF monotherapy developed a second LLR and was successfully switched to a third ATNF.

Conclusion: LLRs secondary to ATNFs are more frequent than previously reported, more common in women and IBD-unclassified. It is reversible with cessation of the culprit agent and steroids. Switching to an alternative ATNF rarely results in recurrence.

Article first published online 31 October 2013

*IBD Center, Department of Gastroenterology and Liver Diseases, Tel Aviv Medical Center, Tel Aviv, Israel;

Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel;

Inflammatory Bowel Disease Center, University of Chicago Medical Center, Chicago, Illinois; and

§Gastroenterology Unit, Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy.

Reprints: Henit Yanai, MD, IBD Center, Department of Gastroenterology and Liver Diseases, Tel Aviv Medical Center, 6 Weizmann Street, Tel Aviv 64239, Israel (e-mail:

R. D. Cohen: has served as a lecturer and consultant for Abbott Laboratories, Janssen (Johnson & Johnson/Ortho Biotech/Centocor), and UCB Pharma, and has received research grants money from Janssen (Johnson & Johnson/Ortho Biotech/Centocor). The remaining authors have no conflicts of interest to disclose.

Received July 20, 2013

Accepted September 06, 2013

© Crohn's & Colitis Foundation of America, Inc.
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