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Rheumatology Advance Access originally published online on April 24, 2009
Rheumatology 2009 48(7):761-764; doi:10.1093/rheumatology/kep083
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© The Author 2009. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Paradoxical adverse events of anti-tumour necrosis factor therapy for spondyloarthropathies: a retrospective study

Damien Fouache1,*, Vincent Goëb2,*, Nathalie Massy-Guillemant3, Gilles Avenel2, Helene Bacquet-Deschryver2, Macha Kozyreff-Meurice2, Jean-François Ménard4, Marc Muraine5, Guillaume Savoye6, Xavier Le Loët2, Christine Tharasse1 and Olivier Vittecoq2

1Department of Pharmacy, University of Medicine–Pharmacy, 2Department of Rheumatology, Rouen University Hospital and Inserm U905 (IFRMP 23), Institute for Biomedical Research, University of Rouen, 3Department of Pharmacovigilance, 4Department of Biostatistics, 5Department of Ophthalmology and 6Department of Hepatogastroenterology, Rouen University Hospital, Rouen, France.

Correspondence to: Vincent Goëb, Service de Rhumatologie, CHU de Rouen, 76031 Rouen, France. E-mail: goebvince{at}yahoo.fr


  Abstract

Objectives. Several paradoxical adverse events (PAEs), e.g. IBDs, acute anterior uveitis (AAU) and psoriasis, have been described in patients taking anti-TNF drugs. This retrospective study aimed to describe the different PAEs that have occurred in a population of SpA patients treated with anti-TNF drugs, and to determine whether they are drug specific.

Methods. Since 2000, we have followed 296 patients with SpA [198 AS, 21 SpA associated with IBD (9 ulcerative colitis, 12 Crohn's disease) and 77 psoriatic arthritis] treated with at least one anti-TNF drug (infliximab, etanercept or adalimumab), and 112 SpA patients treated only with conventional DMARDs who served as controls. Considering the cumulative time of exposure to each anti-TNF agent, the frequencies of new-onset PAEs in exposed patients were calculated.

Results. Respective cumulative exposure times were 287, 290 and 62 patient-years for infliximab, etanercept and adalimumab. We observed the following PAEs: five psoriasis (three under infliximab and one with etanercept or adalimumab), three AAU (1/100 patient-years, all under etanercept) and four IBD (three under etanercept and one under infliximab). There was no significant association among any of these PAEs and a specific anti-TNF agent; nor significant difference in the overall PAEs among patients receiving anti-TNF drugs or controls (P = 0.303), the latter experiencing two psoriasis and three AAU.

Conclusions. Undesirable side effects—IBD, AAU and psoriasis—may appear with anti-TNF drugs. Even if they are, a priori, paradoxical, no evidence supports any PAEs to be anti-TNF agent-specific in SpA.

KEY WORDS: Anti-TNF-{alpha}, Etanercept, Infliximab, Adalimumab, Spondylarthropathies, Paradoxical adverse events, Inflammatory bowel disease, Uveitis, Psoriasis

Submitted 8 September 2008; revised version accepted 17 March 2009.
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