Anti-TNF Therapy Holds Promise for Patients With Coexisting Lupus and RA

A study published in December 2017 analyzed the long-term efficacy and safety profile of anti—tumor necrosis factor (anti-TNF) treatment in 15 patients with rhupus, a rare association defined by the coexistence of both systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) in the same patient. Authors of the study note that, to date, there have been no previous studies regarding the use of anti-TNF agents in the treatment of rhupus.

Researchers conducted an open-label, single-center pilot study comprising 15 patients diagnosed with rhupus from 2003 to 2012 with a disease activity score for 28 joints (DAS28) over 3.2. Patients were monitored at 3, 6, 12, 24, and 60 months using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and DAS28.

Of the 15 patients included in the study, 12 were treated with etanercept for a median duration of 62.5 months, and 3 patients were given adalimumab for a median of 36 months. At baseline, median DAS28 and SLEDAI were 5.94 and 6, respectively, in the 2 groups. After 3 months of treatment, DAS28 and SLEDAI decreased to 3.7 and 4, respectively. The authors found that the tolerability and safety profile of the anti-TNF agents were acceptable, with a severe infection rate of 3 per 100 patient years, and with no lupus flares occurring during the follow-up.

The researchers concluded that anti-TNF treatment resulted in an improvement of articular symptoms with a significant decrease of DAS28 score. The SLEDAI score decreased after 3 months of therapy, and these numbers were sustained during the follow-up. Notably, this score also declined without taking into account the arthritis component of the SLEDAI, which the authors suggest could mean that anti-TNF agents could improve the non-articular features of lupus.

This small-scale study suggested that anti-TNF treatment has a “favorable efficacy, a decrease in the median dose of glucocorticoids, and an acceptable tolerance profile in patients with rhupus with refractive arthritis,” said the researchers.

Reference

Danion F, Sparsa L, Arnaud L, et al. Long-term efficacy and safety of anti-tumour necrosis factor alpha treatment in rhupus: an open-label study of 15 patients. RMD Open. 2017;3:e000555. doi: 10.1136/rmdopen-2017-000555.