RESEARCH - Anti-Remicade and anti-Humira antibodies in relation to response to Humira in Remicade switchers and anti-TNF naive patients

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Ann Rheum Dis. Published Online First: 5 July 2009. doi:10.1136/ard.2009.112847

BMJ Publishing Group Ltd & European League Against Rheumatism.

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Extended Report

Anti-infliximab and anti-adalimumab antibodies in relation to response

to adalimumab in infliximab switchers and anti-TNF naive patients: a

cohort study

Geertje M Bartelds 1, Carla A Wijbrandts 2, T Nurmohamed 3,

O Stapel 4, Willem F Lems 5, Lucien Aarden 4, Ben A C Dijkmans

5, Tak 6 and Gerrit Jan Wolbink 1*

1 Jan van Breemen Institute, Netherlands

2 AMC/University Medical Center, Netherlands

3 VU University medical center, Netherlands

4 Sanquin, Netherlands

5 VU University Medical Center, Netherlands

6 AMC Amsterdam, Netherlands

Abstract

Objective To investigate how antibodies against anti-TNF agents

influence response after switching from infliximab to adalimumab in

rheumatoid arthritis (RA).

Methods: This cohort study consisted of 235 RA patients, all treated

with adalimumab. At baseline fifty-two patients (22%) were previously

treated with infliximab ( " switchers " ), and 183(78%) were anti-TNF

naive. Disease activity (using the DAS28score) and presence of

antibodies against infliximab and adalimumab was assessed. Clinical

response to adalimumab was compared between switchers and anti-TNF

naive patients and their anti-infliximab and anti-adalimumab antibody

status.

Results After 28 weeks of adalimumab therapy the decrease in DAS28

(DAS28) for the 235 patients was 1.6±1.5 (mean±SD). Anti-adalimumab

antibodies were detected in 46 patients (20%). DAS28 was 1.8±1.4 in

patients without anti-adalimumab and 0.6±1.3 in patients with

anti-adalimumab (P<0.0001). Thirty-three out of the 52 switchers (63%)

had anti-infliximab antibodies. Patients with anti-infliximab more

often developed anti-adalimumab than anti-TNF naive patients, (14(27%)

versus 32(18%);(P=0.039)). DAS28 was greater for anti-TNF naive

patients (1.7±1.5) compared to switchers without anti-infliximab

antibodies (DAS28=0.9±1.4) (P=0.009). DAS28 for switchers with

anti-infliximab was 1.2±1.3 and did not differ significantly from

anti-TNF naive patients (P=0.262).

Conclusion Switchers with anti-infliximab antibodies more often

develop antibodies against adalimumab than anti-TNF naive patients.

Response to adalimumab was limited in switchers without

anti-infliximab antibodies, which raises the question whether a second

anti-TNF therapy should be offered to RA-patients who fail on initial

treatment with anti-TNF, in the absence of anti-biological antibodies.

http://ard.bmj.com/cgi/content/abstract/ard.2009.112847v1?papetoc

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