Title:No Correlation between Anti-drug Antibodies and Therapeutic Response
in Tunisian Patients with Chronic Inflammatory Diseases Treated by TNF
Blockers
Volume: 20
Issue: 4
Author(s): Selma Bouden, Lilia Laadhar, Jihene Soua*, Meriam Ben Messaoud, Leila Rouached, Imene Ayadi, Olfa Saidane, Aicha Ben Tekaya, Ines Mahmoud, Sonia Rekik, Héla Sahli Srairi, Rawdha Tekaya, Syrine Bellakhal, Monia Fekih, Leila Abdelmoula and Maryem Kallel
Affiliation:
- Department of Rheumatology, Charles Nicoles Hospital, Tunis El Manar
University, Tunis, Tunisia
Keywords:
Inflammatory diseases, TNF alpha blockers, anti-drug antibodies, trough serum concentration, immunogenicity, disease activity, Crohn's disease, rheumatoid arthritis.
Abstract:
Introduction: Tumor necrosis factor alpha (TNF alpha) blockers such as infliximab
(IFX) and adalimumab (ADA) had significantly changed the course of inflammatory diseases
such as rheumatoid arthritis (RA), spondyloarthritis (SpA) and Crohn's disease (CD). However,
about 30% of patients do not respond to these treatments. This lack of response may be due to the
formation of antibodies against these drugs (anti-drug antibodies: ADAbs). The aim of this study
was to determine the prevalence of ADAbs against IFX and ADA, and the trough serum concentration
of IFX and ADA in RA, SpA or CD patients and to assess their impact on the therapeutic response.
Methods: A cross sectional, multi-centric study was conducted, including patients with RA, SpA
or CD treated with IFX or ADA as a first biotherapy for at least 6 months. ADAbs and trough levels
were measured by an Enzyme Linked Immunosorbent assay (ELISA).
Results: 197 patients were included (57 RA, 73 SpA and 67 CD). ADAbs were positive in 40% of
cases for IFX and 25% for ADA. They were positive in 40% of SpA, 35% of RA, and 21% of CD.
The presence of ADAbs was inversely correlated to the trough levels of IFX and ADA during RA
(p = 0.01 and p < 0.0001), SpA (p < 0.01 and p < 0.0001) and CD (p = 0.001 and p = 0.04). For all
pathologies, the presence of ADAbs was not correlated with disease activity. Concomitant
methotrexate significantly reduced immunogenicity.
Conclusion: In our study, the presence of ADAb and low trough levels seem to not affect the therapeutic
response in patients on TNF alpha antagonists. Other tracks more than immunogenicity
should be investigated to explain the loss of response to these biotherapies.
