Adverse events and efficacy of TNF-alpha blockade with infliximab in patients with systemic lupus erythematosus: long-term follow-up of 13 patients.

Abstract

OBJECTIVE:

To follow-up on all available infliximab-treated SLE patients for safety and long-term efficacy in order to extract information that is useful for planning appropriate controlled trials with infliximab in SLE.

METHODS:

We analysed charts of six patients treated in an open-label safety trial and seven additional patients treated with infliximab on a compassionate care basis for uncontrolled SLE organ inflammation.

RESULTS:

Out of nine patients with lupus nephritis, six had a long-term response after four infusions of infliximab in combination with AZA, lasting for up to 5 years. All five patients with lupus arthritis responded, but this response did not last for >2 months after the last infusion. One additional patient had a long-lasting improvement in SLE interstitial lung disease. No symptoms suggestive of infliximab-induced SLE flares occurred in any patients. Short-term treatment appeared relatively safe, but one patient developed deep-vein thrombosis and several infections. Under long-term therapy, two patients had life-threatening or fatal events, namely CNS lymphoma and Legionella pneumonia. Retreatment and treatment without concomitant immunosuppression led to drug reactions.

CONCLUSIONS:

Short-term therapy with four infusions of infliximab in combination with AZA was relatively safe, and had remarkable long-term efficacy for lupus nephritis and, potentially, also interstitial lung disease. Long-term therapy with infliximab, however, was associated with severe adverse events in two out of three SLE patients, which may have been provoked by infliximab and/or by their long-standing refractory SLE and previous therapies.

• Authors: Martin Aringer, Frederic Houssiau, Caroline Gordon, Winfried B Graninger, Reinhard E Voll, Eva Rath, Guenter Steiner, Josef S Smolen
• Journal: Rheumatology (Oxford, England) (Rheumatology (Oxford)) Vol. 48 Issue 11 Pg. 1451-4 (Nov 2009) ISSN: 1462-0332 [Electronic] England
• PMID: 19748965 (Publication Type: Clinical Trial, Journal Article, Multicenter Study)

Chemical References

• Antibodies, Monoclonal
• Antirheumatic Agents
• Immunosuppressive Agents
• Tumor Necrosis Factor-alpha
• Infliximab
• Azathioprine

Topics

• Adult
• Antibodies, Monoclonal (adverse effects, therapeutic use)
• Antirheumatic Agents (adverse effects, therapeutic use)
• Azathioprine (adverse effects, therapeutic use)
• Drug Administration Schedule
• Drug Therapy, Combination
• Female
• Follow-Up Studies
• Humans
• Immunosuppressive Agents (adverse effects, therapeutic use)
• Infliximab
• Lung Diseases, Interstitial (drug therapy)
• Lupus Erythematosus, Systemic (drug therapy)
• Lupus Nephritis (drug therapy)
• Male
• Middle Aged
• Treatment Outcome
• Tumor Necrosis Factor-alpha (antagonists & inhibitors)