Tumor necrosis factor inhibitor-related autoimmune disorders in pediatric rheumatology practice: a multicenter nationwide study

Abstract

Background The purpose of the study is to evaluate the demographic characteristics, clinical features, and management strategies of TNF inhibitor-related autoimmune disorders (TIRAIDs) in pediatric rheumatology practice. Methods The medical records of 71 pediatric patients treated with a TNF inhibitor for a rheumatologic disease and who exhibited any TIRAIDs during a 10-year period were retrospectively evaluated. Results The prevalence of TIRAIDs was 2.8% among 2450 pediatric patients who needed to use any TNF inhibitor drugs due to a rheumatologic disease. There was a female predominance (n = 40, 56%). TIRAIDs were observed in 49 patients (69%) receiving etanercept, 16 patients (23%) receiving adalimumab, and 6 patients (8%) receiving infliximab. The median time to TIRAIDs was 21.6 months. Non-infectious uveitis (38%) was the most common TIRAID, followed by paradoxical psoriasis (PP) (25%), lupus-like disease (8%), multiple sclerosis (7%), episcleritis (7%), and hidradenitis suppurativa (1%). In 58% of patients, treatment was switched to another TNF inhibitor, while in 42%, it was switched to a non-TNF biological therapy and/or cDMARDs. Complete resolution of TIRAIDs was observed in 63% of the patients. C-reactive protein levels and Juvenile Arthritis Disease Activity Score-27 were significantly higher during the development of TIRAIDs in patients with juvenile idiopathic arthritis compared to the remission period (p < 0.001 and p = 0.041, respectively). Conclusions Among TIRAIDs, non-infectious uveitis and PP were the most frequently observed manifestations, predominantly occurring during etanercept treatment. Disease activity tended to increase during the onset of TIRAIDs. Discontinuation of TNF inhibitor therapy and switching to another biological treatment may be effective in achieving clinical remission. What is known center dot TNF inhibitor-related autoimmune disorders (TIRAIDs) may develop after the prescription of TNF inhibitors. What is knew center dot TIRAIDs most frequently develop during etanercept treatment, followed by adalimumab and infliximab. center dot Management of TIRAIDs involves discontinuation of TNF inhibitor therapy and switching to another biological treatment to help achieve remission. center dot Raising awareness about the risk of TIRAIDs during TNF inhibitor treatments and routinely monitoring patients is essential for early detection and effective treatment of TIRAIDs.