Cookies on this website
We use cookies to ensure that we give you the best experience on our website. If you click 'Continue' we'll assume that you are happy to receive all cookies and you won't see this message again. Click 'Find out more' for information on how to change your cookie settings.

Background: Immunological tolerance in humans using anti-T-cell monoclonal antibodies (mAbs) may be hampered by a pro-inflammatory microenvironment. All clinical trials of such therapies in rheumatoid arthritis (RA), however, have selected patients with active disease at baseline. Concurrent neutralization of inflammation with a TNFα antagonist should maximize the potential of anti-T-cell mAbs to induce tolerance in RA. Aim: To evaluate the safety of combining a TNFα antagonist and CD4 mAb in RA. Design: An iterative pilot study focused on the safety of such combination therapy. Methods: Eight poor prognosis, seropositive RA patients were treated with combined CD4 and TNFα blockade. Prolonged CD4 blockade was achieved with a humanized mAb, and TNFα blockade with a p55 TNF receptor fusion protein. Results: There was a low incidence of classical first-dose reactions to the CD4 mAb, possibly reflecting concomitant TNFα blockade. An unusual anaphylactoid reaction was seen, however, and one patient developed a probable allergic reaction after several infusions. Skin rashes were common, as previously reported with CD4 mAb monotherapy. No serious infections were documented during follow-up, despite CD4+ lymphopenia in some patients. Most patients appeared to demonstrate improved RA disease control after the study. After 17-49 months after therapy, one patient was in remission, one remained off disease modifying anti-rheumatic drugs and five had stable disease, three on previously ineffective doses of methotrexate. Conclusions: We report, for the first time in man, immunotherapy with a combination of an anti-cytokine and an anti-T-cell reagent. We witnessed an unusual first-dose reaction but there were no significant infectious complications. © The Author 2008. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved.

Original publication

DOI

10.1093/qjmed/hcn006

Type

Journal article

Journal

QJM

Publication Date

01/04/2008

Volume

101

Pages

299 - 306