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LP-113 Systemic lupus erythematosus induced by experimental therapy with a combination of monoclonal antibodies against the sars-cov2 surface s-protein
  1. Mariia Aristova,
  2. Tatiana Panafidina,
  3. Tatiana Popkova,
  4. Anna Misiyuk and
  5. Magomed Kurbanmagomedov
  1. Systemic lupus erythematosus laboratory, V.A. Nasonova Research Institute of Rheumatology, Russian Federation


Description Patient, 60 years old. In 2018, symmetrical non-erosive arthritis of the hand joints appeared. According to tests: ACCP, RF, ESR, CRP – normal, ANA – negative. Seronegative rheumatoid arthritis (DAS28 4.7) was diagnosed and methotrexate (MT) 22.5 mg/week was prescribed with a positive effect. Due to arthritis recurrence two years later, methylprednisolone (MP) 4 mg/day, hydroxychloroquine (HCQ) 200 mg/day and MP IV total 1250 mg were prescribed. Then MT dose was increased to 25 mg/week, HCQ to 400 mg/day. In January 2022, the patient had mild COVID-19 confirmed by RT-PCR. On 23/01/22, she was treated with a combination of monoclonal antibodies against SARS-CoV2 surface S-protein (Bamlanivimab 700 mg + Etesivimab 1400 mg). In March 2022, examination revealed arthritis, urtic rash. There were laboratory abnormalities: CRP 6.2mg/L(0–5), ANA 1/320cytopl, anti-dsDNA 200IU/ml(0–25), anti-C1q 24.4IU/ml(0–10), C3 0.83g/L(0.9–1.4). Echocardiography showed no pathology. Given the chronological relationship with the administration of monoclonal antibodies, the late age of onset and the absence of visceral organ involvement, drug-induced lupus (DIL) with skin involvement (anti-C1q vasculitis) was initially diagnosed. Therapy: MP IV 1500 mg total, oral MP 8 mg/day, HCQ 400 mg/day, MT 20 mg/week with positive effect – reduction of arthritis and rash elements. However, considering the persistence of immunological abnormalities (anti-dsDNA 800IU/ml, anti-C1q 27.9IU/ml, C3 0.756g/L) by November 2022, the diagnosis is revised in favor of systemic lupus erythematosus (SLE), SELENA-SLEDAI 4 without clinical manifestations.

Conclusions There are known cases of the development of DIL/SLE against the background of therapy with monoclonal antibodies, mainly TNF-α inhibitors. However, SLE after therapy with Bamlanivimab and Etesivimab are not described in the literature. Dynamic monitoring of the patient allowed to establish a final diagnosis and to prescribe an adequate and effective therapy.

  • COVID-19
  • systemic lupus erythematosus
  • monoclonal antibodies

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