A pilot study of combination anti-cytokine and anti-lymphocyte biological therapy in rheumatoid arthritis
Background: Immunological tolerance in humans using anti-T-cell monoclonal antibodies (mAbs) may be hampered by a pro-inflammatory microenvironment. All clinical trials of such therapies in rheumatoid arthritis (RA), however, have selected patients with active disease at baseline. Concurrent neutral...
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Published in | QJM : An International Journal of Medicine Vol. 101; no. 4; pp. 299 - 306 |
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Main Authors | , , , , , , , |
Format | Journal Article |
Language | English |
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Oxford
Oxford University Press
01.04.2008
Oxford Publishing Limited (England) |
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Abstract | Background: Immunological tolerance in humans using anti-T-cell monoclonal antibodies (mAbs) may be hampered by a pro-inflammatory microenvironment. All clinical trials of such therapies in rheumatoid arthritis (RA), however, have selected patients with active disease at baseline. Concurrent neutralization of inflammation with a TNFα antagonist should maximize the potential of anti-T-cell mAbs to induce tolerance in RA. Aim: To evaluate the safety of combining a TNFα antagonist and CD4 mAb in RA. Design: An iterative pilot study focused on the safety of such combination therapy. Methods: Eight poor prognosis, seropositive RA patients were treated with combined CD4 and TNFα blockade. Prolonged CD4 blockade was achieved with a humanized mAb, and TNFα blockade with a p55 TNF receptor fusion protein. Results: There was a low incidence of classical first-dose reactions to the CD4 mAb, possibly reflecting concomitant TNFα blockade. An unusual anaphylactoid reaction was seen, however, and one patient developed a probable allergic reaction after several infusions. Skin rashes were common, as previously reported with CD4 mAb monotherapy. No serious infections were documented during follow-up, despite CD4+ lymphopenia in some patients. Most patients appeared to demonstrate improved RA disease control after the study. After 17–49 months after therapy, one patient was in remission, one remained off disease modifying anti-rheumatic drugs and five had stable disease, three on previously ineffective doses of methotrexate. Conclusions: We report, for the first time in man, immunotherapy with a combination of an anti-cytokine and an anti-T-cell reagent. We witnessed an unusual first-dose reaction but there were no significant infectious complications. |
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AbstractList | Background: Immunological tolerance in humans using anti-T-cell monoclonal antibodies (mAbs) may be hampered by a pro-inflammatory microenvironment. All clinical trials of such therapies in rheumatoid arthritis (RA), however, have selected patients with active disease at baseline. Concurrent neutralization of inflammation with a TNFα antagonist should maximize the potential of anti-T-cell mAbs to induce tolerance in RA. Aim: To evaluate the safety of combining a TNFα antagonist and CD4 mAb in RA. Design: An iterative pilot study focused on the safety of such combination therapy. Methods: Eight poor prognosis, seropositive RA patients were treated with combined CD4 and TNFα blockade. Prolonged CD4 blockade was achieved with a humanized mAb, and TNFα blockade with a p55 TNF receptor fusion protein. Results: There was a low incidence of classical first-dose reactions to the CD4 mAb, possibly reflecting concomitant TNFα blockade. An unusual anaphylactoid reaction was seen, however, and one patient developed a probable allergic reaction after several infusions. Skin rashes were common, as previously reported with CD4 mAb monotherapy. No serious infections were documented during follow-up, despite CD4+ lymphopenia in some patients. Most patients appeared to demonstrate improved RA disease control after the study. After 17–49 months after therapy, one patient was in remission, one remained off disease modifying anti-rheumatic drugs and five had stable disease, three on previously ineffective doses of methotrexate. Conclusions: We report, for the first time in man, immunotherapy with a combination of an anti-cytokine and an anti-T-cell reagent. We witnessed an unusual first-dose reaction but there were no significant infectious complications. BACKGROUND: Immunological tolerance in humans using anti-T-cell monoclonal antibodies (mAbs) may be hampered by a pro-inflammatory microenvironment. All clinical trials of such therapies in rheumatoid arthritis (RA), however, have selected patients with active disease at baseline. Concurrent neutralization of inflammation with a TNF alpha antagonist should maximize the potential of anti-T-cell mAbs to induce tolerance in RA. Aim: To evaluate the safety of combining a TNF alpha antagonist and CD4 mAb in RA. DESIGN: An iterative pilot study focused on the safety of such combination therapy. METHODS: Eight poor prognosis, seropositive RA patients were treated with combined CD4 and TNF alpha blockade. Prolonged CD4 blockade was achieved with a humanized mAb, and TNF alpha blockade with a p55 TNF receptor fusion protein. RESULTS: There was a low incidence of classical first-dose reactions to the CD4 mAb, possibly reflecting concomitant TNF alpha blockade. An unusual anaphylactoid reaction was seen, however, and one patient developed a probable allergic reaction after several infusions. Skin rashes were common, as previously reported with CD4 mAb monotherapy. No serious infections were documented during follow-up, despite CD4+ lymphopenia in some patients. Most patients appeared to demonstrate improved RA disease control after the study. After 17-49 months after therapy, one patient was in remission, one remained off disease modifying anti-rheumatic drugs and five had stable disease, three on previously ineffective doses of methotrexate. CONCLUSIONS: We report, for the first time in man, immunotherapy with a combination of an anti-cytokine and an anti-T-cell reagent. We witnessed an unusual first-dose reaction but there were no significant infectious complications. Background: Immunological tolerance in humans using anti-T-cell monoclonal antibodies (mAbs) may be hampered by a pro-inflammatory microenvironment. All clinical trials of such therapies in rheumatoid arthritis (RA), however, have selected patients with active disease at baseline. Concurrent neutralization of inflammation with a TNFα antagonist should maximize the potential of anti-T-cell mAbs to induce tolerance in RA. Aim: To evaluate the safety of combining a TNFα antagonist and CD4 mAb in RA. Design: An iterative pilot study focused on the safety of such combination therapy. Methods: Eight poor prognosis, seropositive RA patients were treated with combined CD4 and TNFα blockade. Prolonged CD4 blockade was achieved with a humanized mAb, and TNFα blockade with a p55 TNF receptor fusion protein. Results: There was a low incidence of classical first-dose reactions to the CD4 mAb, possibly reflecting concomitant TNFα blockade. An unusual anaphylactoid reaction was seen, however, and one patient developed a probable allergic reaction after several infusions. Skin rashes were common, as previously reported with CD4 mAb monotherapy. No serious infections were documented during follow-up, despite CD4+ lymphopenia in some patients. Most patients appeared to demonstrate improved RA disease control after the study. After 17-49 months after therapy, one patient was in remission, one remained off disease modifying anti-rheumatic drugs and five had stable disease, three on previously ineffective doses of methotrexate. Conclusions: We report, for the first time in man, immunotherapy with a combination of an anti-cytokine and an anti-T-cell reagent. We witnessed an unusual first-dose reaction but there were no significant infectious complications. Immunological tolerance in humans using anti-T-cell monoclonal antibodies (mAbs) may be hampered by a pro-inflammatory microenvironment. All clinical trials of such therapies in rheumatoid arthritis (RA), however, have selected patients with active disease at baseline. Concurrent neutralization of inflammation with a TNFalpha antagonist should maximize the potential of anti-T-cell mAbs to induce tolerance in RA. To evaluate the safety of combining a TNFalpha antagonist and CD4 mAb in RA. An iterative pilot study focused on the safety of such combination therapy. Eight poor prognosis, seropositive RA patients were treated with combined CD4 and TNFalpha blockade. Prolonged CD4 blockade was achieved with a humanized mAb, and TNFalpha blockade with a p55 TNF receptor fusion protein. There was a low incidence of classical first-dose reactions to the CD4 mAb, possibly reflecting concomitant TNFalpha blockade. An unusual anaphylactoid reaction was seen, however, and one patient developed a probable allergic reaction after several infusions. Skin rashes were common, as previously reported with CD4 mAb monotherapy. No serious infections were documented during follow-up, despite CD4+ lymphopenia in some patients. Most patients appeared to demonstrate improved RA disease control after the study. After 17-49 months after therapy, one patient was in remission, one remained off disease modifying anti-rheumatic drugs and five had stable disease, three on previously ineffective doses of methotrexate. We report, for the first time in man, immunotherapy with a combination of an anti-cytokine and an anti-T-cell reagent. We witnessed an unusual first-dose reaction but there were no significant infectious complications. |
Author | Rebello, P.R.U.B. Waldmann, H. Morgan, A.W. Gooi, H.-C. Emery, P. Hale, G. Isaacs, J.D. Richards, S.J. |
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Snippet | Background: Immunological tolerance in humans using anti-T-cell monoclonal antibodies (mAbs) may be hampered by a pro-inflammatory microenvironment. All... Immunological tolerance in humans using anti-T-cell monoclonal antibodies (mAbs) may be hampered by a pro-inflammatory microenvironment. All clinical trials of... BACKGROUND: Immunological tolerance in humans using anti-T-cell monoclonal antibodies (mAbs) may be hampered by a pro-inflammatory microenvironment. All... |
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SubjectTerms | Adult Antibodies, Monoclonal - therapeutic use Arthritis, Rheumatoid - drug therapy Biological and medical sciences CD4 Antigens - therapeutic use Diseases of the osteoarticular system Dose-Response Relationship, Drug Drug Therapy, Combination Female General aspects Humans Immunologic Factors - therapeutic use Inflammatory joint diseases Lymphocytes - immunology Male Medical sciences Middle Aged Pilot Projects Treatment Outcome Tumor Necrosis Factor-alpha - antagonists & inhibitors |
Title | A pilot study of combination anti-cytokine and anti-lymphocyte biological therapy in rheumatoid arthritis |
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