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Antinuclear and Anti-dsDNA Antibodies Might Predict Anti–TNF- Treatment Failure

But routine screening in treatment recipients ain't necessarily necessary.

Many patients treated with TNF antagonists for psoriasis develop antinuclear antibodies (ANAs), and some develop anti–double-stranded DNA antibodies (anti-dsDNAs). The clinical relevance and underlying mechanism of these developments are unknown. Antibody formation seems to occur especially frequently in infliximab recipients regardless of the indication. Researchers retrospectively examined follow-up data for 97 TNF antagonist recipients to see whether treatment failure was associated with antibody development.

The patients received infliximab, adalimumab, or etanercept therapy for psoriasis; 60 were on their first agent, 22 had been on and stopped one agent, 9 had been on and stopped two agents, and 6 had been on and stopped all three agents. ANAs were present in 16.7%, 54.5%, 77.8%, and 83.3% of these patient groups, respectively; and anti-dsDNAs were found in 1.7%, 27.3%, 33.3%, and 83.3%.

The authors note that patients had positive antibody tests before the presumed treatment failure, and that six patients had positive ANA tests prior to therapy, five of whom were weakly reactive. The researchers found no relation between duration of biologic therapy and antibody presence. They did not analyze the development of antibodies by specific agents or specify which agents were used by patients still receiving their first biologic.

Comment: Should ANA and anti-dsDNA testing become routine for psoriasis patients on TNF antagonist therapy? I would say no. Although the presence of ANA might predict treatment failure, there is no reason to stop therapy in a patient who is demonstrating a clinical response without symptoms or signs of lupus erythematosus. Furthermore, in this study, 16.7% of the 60 patients who were on their first biologic therapy were ANA-positive, and presumably, these patients were having a continued response. Therefore, we might have stopped TNF antagonist therapy needlessly in these patients because of a positive ANA. These findings have not convinced me to order antibody tests routinely in this treatment situation.

— Jeffrey P. Callen, MD

Published in Journal Watch Dermatology January 29, 2010

Citation(s):

Pink AE et al. Antinuclear antibodies associate with loss of response to antitumour necrosis factor- therapy in psoriasis: A retrospective, observational study. Br J Dermatol 2009 Oct 26; [e-pub ahead of print]. (http://dx.doi.org/10.1111/j.1365-2133.2009.09563.x)

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