Higher Disease Burden Associated With Neutralizing ADAs
Patients with inflammatory arthritis who developed neutralizing antidrug antibodies (ADAs) against tumor necrosis factor inhibitors (TNFi) had significantly worse disease activity and physical function than patients without ADAs, according to a study published in Rheumatology and Therapy.
“Over the course of the last few decades, TNFi together with the implementation of a treat-to-target strategy have led to far better treatment outcomes for patients with inflammatory arthritis,” researchers explained in the study background. “However, some patients still experience treatment failure, and in some of these patients this may be related to the development of antidrug antibodies against TNFi.”
The study included 282 outpatients with inflammatory arthritis currently under treatment with TNFi as part of standard care. Among them, neutralizing ADAs were identified in 11 patients.
According to the study, patients with these antibodies had significantly worse physical function, disease activity, and inflammatory markers than patients without neutralizing ADAs. Specifically, the higher disease burden associated with neutralizing ADAs was reflected in the following measures: joint pain, patient’s global assessment of disease activity, Health Assessment Questionnaire, Bath Ankylosing Spondylitis Disease Activity/Functional Index, Short-Form-36 physical functioning scale score, 28-joint Disease Activity Score, Simplified Disease Activity Index, and Maastricht Ankylosing Spondylitis Enthesitis score.
Patients with neutralizing ADAs also showed higher serum calprotectin, C-reactive protein, and numbers of circulating peripheral leukocytes, researchers reported. Additionally, the study found that 46% of patients with neutralizing ADAs were current smokers, compared with 15% of patients without TNFi antibodies.
“We may hypothesize that current smoking more often may lead to development of neutralizing antidrug antibodies in patients with inflammatory arthritis treated with TNFi. However, as this is a cross-sectional observational study, no causality may be drawn,” researchers wrote. “It will be of interest to further explore the topic in a randomized controlled trial.”
—Jolynn Tumolo
Reference
Michelsen B, Berget KT, Kavanaugh A, Haugeberg G. Association between TNFi anti-drug antibodies, smoking, and disease activity in patients with inflammatory arthritis: results from a Norwegian cross-sectional observational study. Rheumatol Ther. 2022;9(4):1171-1179.
