Friday, 15 Feb 2019

You are here

Anti-Drug Antibodies Partly Explain Secondary TNF Inhibitor Failures

An observational study of patients with active rheumatoid arthritis (RA) or spondyloarthritis (SpA) experiencing secondary failure to TNF inhibitor (TNFi) therapy showed that (secondary) loss of efficacy to a TNFi was associated with anti-drug antibodies in less than 30% of patients. 

Investigators analyzed and compared 570 patients treated with etanercept (ETN), infliximab (INF) or adalimumab (ADL). Compared with SpA (n = 294) patients, RA patients (n = 276) were more likely to be female (80 vs 39%), older (56 vs 48 years), on DMARDs (83 vs 47%) and had slightly longer disease control for longer (202 vs 170 weeks) before their secondary TNFi failure.

No anti-drug antibodies were found with ETN, but were seen INF (27.1%) and ADA (29.0%) treated patients; 81% of these had no detectable serum drug levels.

While significiantly more SpA (31.3%) patients had anti-INF antibodies than RA (21.1%; P = 0.014), there were few patients patients developing anti-drug antibodies while on concomitant DMARDs (16.5%) compared to those on on monotherapy (26.4%; P < 0.05).

While these data show the potential impact of anti-drug antibodies in the loss of TNFi, efficacy, it appears to be a minor role (<30% of patients) and is not otherwise explained by concomitant DMARD use or the disorder under treatment.  Secondarly anti-TNF failure appears to have multiple etiologies.

The author has no conflicts of interest to disclose related to this subject

Rheumatologists' Comments

How to order for drug antibodies for those of us in community practice?

More Like This

Higher Infection Rates for Infliximab in Psoriasis

A prospective study of psoriasis patients from the British Association of Dermatologists Biologic Interventions Register demonstrated that infliximab therapy yielded 2-3 times more serious infection than seen in those treated with non-biologic DMARDs or methotrexate (MTX).

Biomarker Combo Predicts TNF Inhibitor Responses

Based on clinical trial data, patients starting tumour necrosis factor-alpha inhibitors (TNFi) have roughly a two-thirds chance of achieiving a good clinical response. French investigators have studied a series of potential biomarkers and surmised that the combination of baseline prealbumin, platelet factor 4 and S100A12 can predict a 78% response to TNFi in rheumatoid arthritis (RA) patients.

TNF Inhibitors Don't Increase Cancer Risk in Children

While the risk of neoplasia with tumour necrosis factor inhibitor (TNFi) use has been largely nullified in most inflammatory disorders, this risk in children is less certain. However a recent study shows no risk of increased cancer in children treated with TNFi for juvenile idiopathic arthritis (JIA), pediatric inflammatory bowel disease (pIBD) and pediatric plaque psoriasis (pPsO).

Risk of Psoriasis Complicating TNF Inhibitor Therapy

A population-based study of claims data from Korea shows that among inflammatory bowel disease (IBD) patients receiving tumour necrosis factor inhibitors (TNFi) there is a 3.7 per 100 patient-year risk of paradoxically developing psoriasis - a rate that is roughly 3-fold higher than risk in TNFi-naive IBD patients.

Favorable Certolizumab Safety Profile in Pregnancy

Clowse and colleagues have published an extensive review of the certolizumab pegol (CZP) in pregnancy database, and found no evidence that CZP has a teratogenic effect or contributes to fetal harm when compared to the general population.