AB1205 PARADOXICAL BIOLOGICS-INDUCED AUTOIMMUNE DISEASES
Authors: N. Alcorta Lorenzo, A. De Diego Sola, J. A. Valero Jaimes, C. A. Egües, J. J. Cancio Fanlo, L. M. Lopez Dominguez, O. Maiz-Alonso, J. M. Belzunegui Otano, E. Uriarte Isacelaya
Journal: Annals of the Rheumatic Diseases (2020)

Background: Biological therapies have revolutionized the management of rheumatic diseases. This study analyzes the paradoxical autoimmune inflammatory manifestations that these therapies can induce. They are described as paradoxical because these are diseases in which the same biological drugs have proven effective. Objectives: The aim of this study is to carry out a descriptive analysis of paradoxical biologics-induced autoimmune manifestations. Methods: A retrospective research was carried out during January 2017 and March 2018 at Hospital Universitario Donostia. Computerized medical records were reviewed. The following variables were recorded: underlying disease; type of developed manifestation; the triggering biologic drug and its duration; concomitant treatment with disease-modifying antirheumatic drugs (DMARDs), previous biological treatments; the adopted measure and the resolution of the complication or not. Qualitative variables are recorded in absolute value and in percentage. The quantitative variables are recorded with the mean and standard deviation. The data has been analyzed with the SPSS Statistics 20 program. Results: Twenty-six cases were analyzed. The most common triggering drugs were infliximab (30.8%), adalimumab (30.8%) and etanercept (15.4%). The most common underlying diseases were spondyloarthritis (42.3%), rheumathoid arthritis (34.6%) and Crohn’s disease (11.5%). The most developed complications were cutaneous affectations (76.9%), psoriasis specifically. Statistical significative difference regarding the molecules causing the complication, has only been found in the previous use of biologic drugs (p 0.003), number of treatment dropouts (p 0.048) and number of resolved complications (regardless of the adopted measure) (p 0.041). Conclusion: Infliximab and adalimumab are the drugs that presented the most paradoxical manifestations, probably because they are the oldest and most used ones. The difference found in previously used biologics, could be due to the fact that new drugs are less frequently presented as the first option. Psoriasis is the most frequently developed complication. The difference found in the number of abandonments of the biologic treatment and the solution of the complication might be more associated with the complication itself, rather than with the responsible molecule. There is no consensus on the measures to be taken when facing the complication. The severity of the manifestation should be assessed, as well as the control of the underlying disease. Most complications resolve overtime. Table 1 Infliximab n 8 (31.8%) Adalimumab n 8 (30.8%) Etanercept n 4 (15.4%) Certolizumab n 2 (7.7%) Golimumab n 2 (7.7%) Abatacept n 1 (3.8%) Tocilizumab n 1 (3.8%) Total n 26 (100.0%) p value Underlying disease 0.789 Rheumatic (%) 6 (75.0) 5 (62.5) 4 (100.0) 2 (100.0) 2 (100.0) 1 (100.0) 1 (100.0) 21 (80.0) Digestive (%) 2 (25.0) 3 (37.5) 0 0 0 0 0 5 (19.2) Type of developed manifestation 0.235 Hematologic (%) 0 1 (12.5) 0 0 0 0 0 1 (3.8) Neurologic (%) 2 (25.0) 0 0 0 0 0 0 2 (7.7) Digestive (%) 0 0 0 0 1 (50.0) 0 0 1 (3.8) Cutaneous (%) 6 (75.0) 6 (75.0) 4 (100.0) 2 (100.0) 1 (50.0) 0 1 (100.0) 20 (76.9) Other (%) 0 1 (12.5) 0 0 0 1 (100.0) 0 2 (7.7) Table 2 Infliximab n 8 Adalimumab n 8 Etanercept n 4 Certolizumab n 2 Golimumab n 2 Abatacept n 1 Tocilizumab n 1 Total n 2 p value The triggering biologic drug and its duration (months) 43.25 (SD 44.81) 10.93 75.50 (SD 66.08) 4.50 11.00 6.00 5.00 30.66 0.635 Concomitant treatment with DMARDs (%) 2 (25.0) 2 (25.0) 1 (25.0) 1 (50.0) 0 0 1 (100.0) 7 (26.9) 0.811 Previous biological treatment (%) 0 2 (25.0) 1 (25.0) 2 (100.0) 2 (100.0) 1 (100.0) 1 (100.0) 9 (34.6) 0.003 Suspension as the adopted measure (%) 5 (62.5) 7 (87.5) 0 2 (100.0) 1 (50.0) 1 (100.0) 1 (100.0) 17 (65.4) 0.048 Resolution of the complication (%) 3 (37.5) 8 (100.0) 1 (25.0) 1 (50.0) 1 (50.0) 1 (100.0) 1 (100.0) 16 (64.0) 0.041 Disclosure of Interests: None declared