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SAT0074 No Need To Detect Anti-Drug Antibodies in Patients Treated with Tnf Inhibitors
  1. M. Herold1,
  2. L. Boso2,
  3. T. Haueis2,
  4. W. Klotz1,
  5. G. Zangerl3
  1. 1Department of Internal Medicine VI, Medical University of Innsbruck, Innsbruck
  2. 2Landeskrankenhaus Bludenz, Bludenz
  3. 3Rheumatologist in private practice, Zams, Austria

Abstract

Background Formation of anti-drug antibodies (ADA) might be responsible for sub-therapeutic serum drug levels resulting in a lack of clinical response. The need to test ADA levels in patients treated with a TNF inhibitor is the subject of discussion (1, 2).

Objectives ADA levels were measured in patients treated with ADL or ETN or IFX to check immunogenicity in patients receiving various TNF inhibitors and clarify whether ADA measurement reflects treatment output.

Methods Frozen serum samples from patients with rheumatoid arthritis (RA), spondylarthritis (SpA) and psoriasis arthritis (PsA) and treated with adalimumab (ADL; n=41) or etanercept (ETN; n=42) or infliximab (IFX; n=42) were selected. All patients were receiving continuous care of one of the authors. Anti-ADL, anti-ETN or anti-IFX levels were tested with commercially available assays (Grifols Deutschland GmbH) according to the manufacturer's instructions. Drug levels were also determined with assays from the same manufacturer.

Results Among ADL-treated patients we found 8/41 (20%) to be positive for ADA. In the ETN group elevated ADA levels were found in 3/42 (7%) patients; in the IFX group 8/42 (19%) patients had positive ADA levels. High ADA concentrations did not always correlate with diminished therapeutic response. Among ADA positive patients 3/8 in the ADL group (1 of each disease), 3/3 in the ETN group (RA 2, SpA 1) and 5/8 in the IFX group (RA 1, PsA 3, SpA 2) continued the given therapy with good response. The three positive ETN patients showed only borderline elevated ADA levels.

Conclusions ADA levels were more often found in patients treated with ADL or IFX than with ETN. These results agree with those of previous studies (3) and might indicate differences in immunogenicity between these three TNF inhibitors. Nevertheless positive ADA levels did not always indicate failure of therapy. The low incidence of ADA levels, the high cost of ADA assays and the absence of a need to change therapy based on ADA levels have to be considered before ADA analysis is ordered within a routine control.

  1. Meroni PL, Valentini G, Ayala F, Cattaneo A, Valesini G. New strategies to address the pharmacodynamics and pharmacokinetics of tumor necrosis factor (TNF) inhibitors: A systematic analysis. Autoimmun Rev. 2015;14:812–29. doi: 10.1016/j.autrev.2015.05.001

  2. Murdaca G, Spanò F, Contatore M, Guastalla A, Penza E, Magnani O, Puppo F. Immunogenicity of infliximab and adalimumab: what is its role in hypersensitivity and modulation of therapeutic efficacy and safety? Expert Opin Drug Saf. 2016;15:43–52. doi: 10.1517/14740338.2016.1112375

  3. Arstikyte I, Kapleryte G, Butrimiene I, Venalis A. Influence of immunogenicity on the efficacy of long-term treatment with TNFα blockers in rheumatoid arthritis and spondyloarthritis patients. Biomed Res Int. 2015;2015:604872. doi: 10.1155/2015/604872

Acknowledgement This study was supported by PFIZER within an unlimited industrial grant.

Disclosure of Interest None declared

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