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Anti-infliximab antibodies associated with treatment failure after IBD patients switched to adalimumab
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Patients with inflammatory bowel disease who developed antibodies against infliximab were more likely to develop antibodies against adalimumab and experience therapeutic failure after switching treatments, according to new research data.
Casper Steenholdt, MD, PhD, department of medical gastroenterology, Herlev University Hospital, Denmark, and colleagues performed a retrospective single-center cohort study to evaluate whether IBD patients who tested positive for anti-infliximab (IFX) antibodies were more likely to develop anti-adalimumab (ADL) antibodies when switching therapies. They also assessed the effect that anti-ADL antibodies had on clinical outcomes.
Casper Steenholdt
Of 187 patients evaluated for anti-IFX antibodies after a median of six infusions, 49% tested positive, and of the 57 patients evaluated for anti-ADL antibodies after a median of 9 months of therapy, 21% tested positive. Patients who tested positive for anti-IFX and anti-ADL antibodies had undetectable IFX and ADL levels compared with those who tested negative (both P<.0001). Researchers said this indicated that the antibodies were functional, but anti-IFX antibodies did not cross react with ADL.
Patients who developed anti-IFX antibodies had increased risk for developing anti-ADL antibodies vs. those who did not (33% vs. 0%; P=.04). Developing anti-ADL antibodies increased the risk for secondary ADL treatment failure (P<.001). ADL trough levels were associated with efficacy of ADL maintenance therapy regardless of anti-ADL antibody status (P<.01).
“This study shows that IBD patients who have previously developed antibodies against infliximab are prone to also develop antibodies against adalimumab after switching to adalimumab therapy,” Steenholdt told Healio.com/Gastroenterology. “As anti-adalimumab antibodies were found to reduce trough serum levels of adalimumab and associate with treatment failure, adalimumab immunogenicity needs to be monitored closely in anti-infliximab antibody-positive switchers to secure rational and timely interventions, and to avoid inappropriate drug usage.”
Disclosure: See the study for a full list of relevant financial disclosures.
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