Vasculitis Associated With Tumor Necrosis Factor-α Inhibitors

• Published in: Mayo Clinic proceedings Vol. 87; no. 8; pp. 739 - 745
• Main Authors: Sokumbi, Olayemi, MD, Wetter, David A., MD, Makol, Ashima, MBBS, Warrington, Kenneth J., MD
• Format: Journal Article
• Language: English
• Published: Rochester, MN Elsevier Inc 01.08.2012; Mayo Foundation; Elsevier, Inc
• Subjects: Adalimumab; Adult; Aged; Anti-Inflammatory Agents - adverse effects; Anti-inflammatory drugs; Antibodies, Monoclonal - adverse effects; Antibodies, Monoclonal, Humanized - adverse effects; Antibodies, Monoclonal, Murine-Derived - therapeutic use; Arthritis, Rheumatoid - drug therapy; Azathioprine - therapeutic use; Biological and medical sciences; Colitis, Ulcerative - drug therapy; Complications and side effects; Crohn Disease - drug therapy; Cyclophosphamide - therapeutic use; Diagnosis; Dosage and administration; Etanercept; Female; General aspects; Glucocorticoids - therapeutic use; Health aspects; Hematuria - etiology; Humans; Immunoglobulin G - adverse effects; Immunologic Factors - therapeutic use; Infliximab; Internal Medicine; Male; Medical sciences; Methotrexate - therapeutic use; Middle Aged; Mycophenolic Acid - analogs & derivatives; Mycophenolic Acid - therapeutic use; Original; Polyneuropathies - etiology; Prednisone - therapeutic use; Proteinuria - etiology; Receptors, Tumor Necrosis Factor; Retrospective Studies; Risk factors; Rituximab; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Tumor necrosis factor; Tumor Necrosis Factor-alpha - antagonists & inhibitors; Vasculitis; Vasculitis - chemically induced; Vasculitis - drug therapy; Young Adult; United States; IBD; TNF-α; rheumatoid arthritis; tumor necrosis factor-α; inflammatory bowel disease; RA; Vascular disease; Medicine; Association; Vasculitis; Cytokine; Risk factor; Anti-TNF; Cardiovascular disease; Tumor necrosis factor α
• ISSN: 0025-6196; 1942-5546
• DOI: 10.1016/j.mayocp.2012.04.011

Abstract Objective To describe the clinical characteristics, histopathologic features, and outcomes of patients in whom vasculitis developed in association with use of tumor necrosis factor-α (TNF-α) inhibitors. Patients and Methods This is a retrospective review of patients evaluated at Mayo Clinic, Rochester, Minnesota, from January 1, 1998, through March 31, 2011, with a diagnosis of vasculitis induced by anti–TNF-α therapy. Results Of 8 patients with vasculitis associated with anti–TNF-α therapy (mean age, 48.5 years), 6 (75%) were female. Four (50%) had rheumatoid arthritis, 1 (13%) had Crohn disease, and 3 (38%) had ulcerative colitis. Five (63%) were treated with infliximab, 2 (25%) with etanercept, and 1 (13%) with adalimumab. The mean duration of treatment before development of vasculitis was 34.5 months. The skin was the predominant organ affected (5 patients [63%]), with the most common cutaneous lesion being palpable purpura (4 of 5 [80%]). Two organs involved in systemic vasculitis were the peripheral nervous system (4 patients [50%]) and kidney (1 patient [13%]). All cases of vasculitis were histopathologically confirmed. Seven of 8 patients improved with discontinuation of therapy (mean time to resolution, 6.9 months) and adjuvant treatment (all 8 received prednisone; another agent was also used in 7); rechallenge with anti–TNF-α therapy was not attempted in any patient. At last follow-up, no patients had experienced a recurrence of vasculitis after therapy discontinuation. Conclusion Cutaneous small-vessel vasculitis was the most common finding, but systemic vasculitis, including peripheral nerve and renal vasculitis, was also frequently observed.