Infliximab induces a dysregulated tissue-homing profile on human T-lymphocytes in-vitro: A novel mechanism for paradoxical inflammation?

Dear Sir, Paradoxical inflammation (PI) is defined as the development of inflammatory lesions in patients with immune mediated inflammatory disease after initiation of treatment with anti tumor necrosis factor alpha (anti TNF-alpha) agents, normally used to treat them.1 For example, a patient with Crohn's disease (CD) can paradoxically experience the onset of another immune mediated inflammatory process (e.g. psoriasis), suggesting the ability of anti TNF-alpha agents to promote inflammation at remote sites in some patients. The development of inflammatory skin disorders following anti TNF-alpha therapy for inflammatory bowel disease (IBD) is an emerging problem. A recent prospective study of 562 patients initiated on anti TNF-alpha treatment for IBD, demonstrated a 5% incidence of PI (3% eczematiform and 2% psoriasaiform).2 Other studies have found the incidence rate of paradoxical skin lesions to be higher: Fidder et al. 9% of 743 patients with IBD treated with infliximab (IFX) …