Anti-drug antibodies linked with TNF inhibitor treatment failure in noninfectious uveitis
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Higher anti-drug antibody levels were associated with an increased risk for tumor necrosis factor inhibitor treatment failure in patients with noninfectious uveitis who received adalimumab, according to a study.
“Anti-drug antibodies (ADAs) can be a potential cause of treatment failure in patients treated with TNFi for noninfectious uveitis, and therapeutic drug monitoring may help exclude ADAs as a potential cause of treatment failure,” study authors Sunil Bellur, MD, and Shilpa Kodati, MD, told Healio/OSN.
The retrospective cross-sectional study included 54 patients with noninfectious uveitis who were treated with either adalimumab (42 patients) or infliximab (12 patients) and underwent testing for ADAs and serum drug level at the National Eye Institute from 2017 to 2021.
In the study, 35.7% of patients treated with adalimumab developed ADAs, with a mean drug level of 9.72 µg/mL and a mean ADA level of 84.2 arbitrary units (AU)/mL.
The mean drug level was lower in patients with ADAs compared with those without them (2.8 µg/mL vs. 13.6 µg/mL; P < .001). The mean drug level was higher with concurrent antimetabolite use compared with monotherapy (11 µg/mL vs. 6.8 µg/mL), but the difference was not statistically significant.
The study found that the presence of ADAs in patients receiving adalimumab was associated with a mean difference of –11 µg/mL in mean drug level. There was a mean decrease of 0.02 µg/mL in mean drug level associated with each increase of 1 AU in antibody level, “suggesting an antibody level-dependent inverse association between ADAs and drug levels,” the authors said. No ADAs were detected in patients who received infliximab.
According to the study, the association found between ADAs and tumor necrosis factor inhibitor (TNFi) treatment failure suggests that therapeutic drug monitoring is an option for patients with noninfectious uveitis who are experiencing treatment failure to help exclude ADAs as a potential cause of it.
“Longitudinal prospective studies with a standardized protocol regarding anti-drug antibody testing intervals and TNFi dosing regimens are needed to clarify the role of therapeutic drug monitoring and the association of ADAs with TNFi treatment in patients with noninfectious uveitis,” Bellur and Kodati told Healio/OSN.
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