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RA disease activity higher in patients with anti-adalimumab antibodies
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The presence of anti-adalimumab antibodies was associated with decreased efficacy of adalimumab therapy in patients with rheumatoid arthritis, and serum levels of antibodies should be monitored periodically, according to new research.
A cohort of 57 patients with rheumatoid arthritis (RA) diagnosed using American College of Rheumatology criteria who were treated with adalimumab (Humira, AbbVie) in addition to a disease-modifying anti-rheumatic drug (DMARD) for at least 3 months was studied. Mean treatment length was 2.7 years. Adalimumab was the first anti-tumor necrosis factor treatment received by 80.7% of the patients.
Researchers collected data regarding patient age, sex, body mass index, RA diagnosis date, duration of adalimumab treatment and laboratory data, which included serum tests for rheumatoid factor, anti-cyclic citrullinated peptides antibodies, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP).
Disease activity was calculated using disease activity score in 28 joints (DAS28) and the simplified disease activity index (SDAI), and serum levels of adalimumab and anti-adalimumab antibodies were measured prior to patients’ next injection of the drug.
Positive anti-adalimumab antibodies were seen in four patients, and patients with positive antibodies showed significantly lower adalimumab concentrations and higher mean DAS28 scores than those with negative antibodies, according to the researchers.
The researchers also found patients with DAS28 scores of 3.2 or less had significantly better SDAI scores, higher adalimumab serum concentrations and no anti-adalimumab antibodies compared with patients whose DAS28 scores were greater than 3.2.
Using patients’ serum adalimumab levels, the researchers separated the patients into three groups; those with levels less than 5.5 mg/L were in the “low-level” group, those with levels from 5.5 mg/L to 11.3 mg/L were classified as “medium level” and those with levels greater than 11.3 mg/L were classified as “high level.” According to the researchers, patients in the medium group were closed to clinical remission, whereas those in the high group were on clinical remission.
“Serum [adalimumab] levels should be monitored periodically to maintain levels greater than 4.3 mg/L. Patients with [adalimumab] levels greater than 11.3 mg/L may be candidates to increase the interval between doses,” the researchers concluded.
Disclosure: The authors did not report any financial disclosures.
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