Autoimmune Complications From Biologic Agents

Abstract

Introduction: Biologic agents including anti-tumor necrosis factor (TNF) agents are used for the treatment of a number of disease processes including inflammatory bowel disease, rheumatic diseases, and other autoimmune diseases. As their use has grown, there have been increasing reports of autoimmune diseases induced by the biologic agents. The purpose of this study is to review the incidence, the clinical characteristics, and the treatment of autoimmune diseases induced by biologic agents. Methods: An automated data extraction was performed at a tertiary medical center from 2013 to 2017. Patients above the age of 18 who had received any of the following biologic agents; infliximab, adalimumab, etanercept, certolizumab, vedolizumab, & ustekinumab, at an affiliated infusion center and who had a diagnosis of Crohn's disease, ulcerative colitis, lupus (SLE), psoriasis, autoimmune hepatitis, vasculitis, interstitial lung disease (ILD), sarcoidosis, arthritis, rheumatoid arthritis, migratory arthritis, myopathies, multiple sclerosis, and Guillain-Barre syndrome (GBS), were included in the study. 515 patients were analyzed. The charts of patients with more than 2 of the above diagnoses were manually reviewed and 20 patient were found with autoimmune complications. Results: The prevalence of autoimmune complications amongst patients on biologic agents is 3.88%. Drug-induced psoriasis and lupus were the most common autoimmune complications. 95% patients with an autoimmune complication had an underlying inflammatory bowel disease. All 20 of the observed complications occurred with anti-tumor necrosis factor agents; 85% of patients were on infliximab. Table 1 describes the clinical characteristics of the patients and their treatment course.Table: Table. Autoimmune ComplicationsConclusion: Various autoimmune complications have been linked with the biologic agents. The rates of autoimmune complications appear to be higher in patients with inflammatory bowel diseases and with patients on anti-TNF agents. The most common autoimmune complication is psoriasis. Most patients' autoimmune complications can be treated conservatively with control of symptoms but for more refractory cases, the patient may need to be transitioned to a different biologic agent or class.