RESEARCH - Formation of antibodies against Remicade and Humira strongly correlates with functional drug levels and clinical responses in RA

[Guest guest]

Ann Rheum Dis. 2008 Nov 19.

Formation of antibodies against infliximab and adalimumab strongly

correlates with functional drug levels and clinical responses in

rheumatoid arthritis.

Radstake TR, Svenson M, Eijsbouts AM, van den Hoogen FH, Enevold C,

van Riel PL, Bendtzen K.

University Medical Center Nijmegen, Netherlands.

Introduction: TNF-alpha neutralizing antibody constructs are

increasingly being used to treat rheumatoid arthritis (RA). The

current study focused on potential differences in clinical responses,

soluble drug levels and antibody formation between RA patients

receiving infliximab and adalimumab.

METHODS: RA patients, 69, fulfilling the 1987 ACR criteria and about

to start treatment with infliximab or adalimumab, were enrolled

consecutively. All patients had active disease DAS28 > 3.2. Infliximab

was given intravenously at 3 mg/kg at baseline and after 2, 6 and 14

weeks. Adalimumab was administered as 40 mg biweekly s.c. Concomitant

medication was monitored and continued at constant dosage during the

study. All sera were tested for infliximab/adalimumab levels and

anti-infliximab/anti-adalimumab antibodies.

RESULTS: Infliximab was administered to 35 patients, 34 received

adalimumab. At six months, 15 (43%), 6 (17%) and 14 (40%) of the

infliximab-treated patients fulfilled the EULAR criteria for good,

moderate and non-responders, respectively, whereas the corresponding

figures for adalimumab treated patients were 16 (47%), 8 (24%) and 10

(29%). Clinical responses correlated with the levels of

S-infliximab/adalimumab and the formation of

anti-infliximab/anti-adalimumab antibodies.

Discussion: We demonstrate that the clinical response to two

anti-TNF-alpha biologicals closely follows the trough drug levels and

the presence of antibodies directed against the drugs. Further studies

that focus on the underlying pathways leading to antibody formation

are warranted to predict immunogenicity of these expensive biologicals

and treatment outcomes.

PMID: 19019895

http://www.ncbi.nlm.nih.gov/pubmed/19019895

Not an MD