Influence of Immunogenicity on the Efficacy of Long-Term Treatment with TNF α Blockers in Rheumatoid Arthritis and Spondyloarthritis Patients

الملخص EN

Objective.

To analyze the clinical relevance of the levels of TNFα blockers and anti-drug antibodies (anti-drug Ab) in patients with rheumatoid arthritis (RA) and spondyloarthritis (SpA) treated with adalimumab (ADA), etanercept (ETA), or infliximab (INF) for a prolonged period of time.

Methods.

Clinical characteristics (disease activity, and adverse events), serum TNFα blockers, and anti-drug Ab levels were evaluated in 62 RA and 81 SpA patients treated with TNFα blockers for a median of 28 months.

Results.

Anti-ADA Ab were detected in 1 (4.0%) and anti-INF Ab in 14 out of 57 (24.6%) RA and SpA patients.

Patient with anti-ADA Ab and 57.1% patients with anti-INF Ab were considered nonresponders to treatment.

Anti-ETA Ab were not found in any of 61 ETA treated patients.

Anti-ADA and anti-INF Ab levels differ between responders and nonresponders ( P > 0.05 ) .

Three (5.3%) patients with high serum anti-INF Ab levels developed infusion related reactions.

Patients with anti-INF Ab more often required changing to another biologic drug (OR 11.43 (95% CI 1.08–120.93)) and treatment discontinuation (OR 9.28 (95% CI 1.64–52.52)).

Conclusion.

Patients not responding to treatment had higher serum anti-ADA and anti-INF Ab concentrations.

Anti-INF Ab formation is related to increased risk of infusion related reactions, changing to another biologic drug, and treatment discontinuation.