Characterization of patients with infliximab-induced lupus erythematosus and outcomes after retreatment with a second anti-TNF agent

Background: Drug-induced lupus erythematosus (DILE) due to infliximab therapy for inflammatory bowel disease (IBD) is an uncommon occurrence. It remains uncertain whether patients with infliximab-induced DILE could tolerate another antitumor necrosis factor (TNF) agent without recurrent DILE. Methods: We reviewed the case records of patients with infliximab-induced DILE diagnosed at our institute and noted details of their clinical and immunological profile at presentation. In addition, case notes of patients who were treated with a second anti-TNF agent were examined for evidence of recurrent DILE. Results: Thirteen patients with infliximab-induced DILE were identified with a female-to-male ratio of 11:2. Symmetric large joint arthralgias and high titers of antinuclear and antidouble-stranded DNA antibody were noted in all patients. Eight patients were retreated with a second anti-TNF agent (six certolizumab pegol and two adalimumab) of whom two patients (one adalimumab and certolizumab pegol each) developed recurrent DILE following 3 months of therapy with a second anti-TNF agent. One patient discontinued therapy after 2 months despite no recurrence of DILE, due to fear of side effects. Five patients remain well with no recurrence of DILE after a median of 5 months (range 2-6) therapy. Conclusions: Rechallenge with a further anti-TNF agent in patients who have developed DILE with infliximab is associated with a low rate of recurrence.