ABSTRACT
Background
Flares or onset of inflammatory bowel disease in association with immunosuppression
has been reported in the literature.
Methods
We studied 4 cases of patients with rheumatic disease who developed or had a flare
of ulcerative colitis either after initiation of or while taking a tumor necrosis
factor-α inhibitor.
Results
We identified 4 patients, three male and one female. Two of the male patients had
a seronegative spondyloarthropathy and one had rheumatoid arthritis. The female patient
had amyopathic dermatomyositis. Two of the 4 patients had ulcerative colitis prior
to tumor necrosis factor-α treatment. Both of these patients had quiescent ulcerative colitis that flared after
they began taking etanercept. Two patients developed de novo ulcerative colitis while
taking a tumor necrosis factor-α inhibitor.
Conclusions
The data presented in these 4 cases supports a temporal relationship between initiating
a tumor necrosis factor-α inhibitor and onset or flare of ulcerative colitis. These observations raise the
possibility that tumor necrosis factor-α inhibitor therapy, which has been used as treatment for inflammatory bowel disease,
may rarely be a factor in the development of disease.
KEY INDEXING TERMS
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References
- Recombinant human tumor necrosis factor receptor (etanercept) for treating ankylosing spondylitis.Arthritis Rheum. 2003; 48: 3230-3236
- Efficacy of etanercept for treatment of Crohn’s related spondyloarthritis but not colitis.Ann Rheum Dis. 2003; 62: 74-76
- Development of Crohn disease during anti-TNF-α therapy in a child with juvenile idiopathic arthritis.J Pediatr Gastroenterol Nutr. 2004; 39: 203-206
- Development of ulcerative colitis after heart transplantation during immunosuppressive therapy.Z Gastroenterol. 2005; 43: 195-204
- Cross-regulation of TNF and IFN-α in autoimmune diseases.Proc Natl Acad Sci. 2005; 102: 3372-3377
- Strategies for targeting tumor necrosis factor in IBD.Best Pract Res Clin Gastroenterol. 2003; 17: 105-117
- New concepts in anti-tumor necrosis factor therapy for inflammatory bowel disease.Rev Gastroenterol Disord. 2005; 5: 10-18
Article info
Publication history
Accepted:
September 19,
2006
Received:
May 29,
2006
Footnotes
Stanley B. Cohen is a clinical investigator and research consultant for Genentech, Biogen-IDEC, Merck, Aventis, Proctor & Gamble, Pfizer, Centocor, Amgen, Scios, and Wyeth-Ayerst. Salahuddin Kazi has grant support from Abbot Laboratories and is on the speakers’ bureau for Centocor. Salahuddin Kazi and Kara Prescott are employees of the United States Federal Government.
Identification
Copyright
© 2007 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.
