Influence of Immunogenicity on the Efficacy of Long-Term Treatment with TNFα Blockers in Rheumatoid Arthritis and Spondyloarthritis Patients
Influence of Immunogenicity on the Efficacy of Long-Term Treatment with TNFα Blockers in Rheumatoid Arthritis and Spondyloarthritis Patients
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DOI：
10.1155/2015/604872
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发表时间：
2015-01-01
影响因子：
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通讯作者：
Venalis, Algirdas
中科院分区：
文献类型：
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作者：
Arstikyte, Inesa;Kapleryte, Giedre;Venalis, Algirdas
Objective.分析长期接受阿达木单抗（ADA）、依那西普（ETA）或英夫利昔单抗（INF）治疗的类风湿关节炎（RA）和脊柱关节炎（SpA）患者中TNF α阻滞剂和抗药抗体（抗药Ab）水平的临床相关性。方法.在62例RA和81例SpA患者中评价了临床特征（疾病活动和不良事件）、血清TNF α阻滞剂和抗药Ab水平，这些患者接受了中位时间为28个月的TNF α阻滞剂治疗。结果在57例RA和SpA患者中，1例（4.0%）检测到抗ADA抗体，14例（24.6%）检测到抗INF抗体。抗ADA Ab患者和57.1%抗INF Ab患者被认为是治疗无应答者。在61例ETA治疗的患者中未发现抗ETA抗体。应答者和无应答者的抗ADA和抗INF抗体水平差异无统计学意义（P > 0.05）。3例（5.3%）血清抗INF Ab水平高的患者发生了输注相关反应。抗INF Ab患者更常需要更换为另一种生物制剂药物（OR 11.43（95% CI 1.08-120.93））和停止治疗（OR 9.28（95% CI 1.64-52.52））。结论对治疗无反应的患者血清抗ADA和抗INFAb浓度较高。抗INFAb形成与输注相关反应、改用另一种生物药物和治疗停止的风险增加有关。
Objective. To analyze the clinical relevance of the levels of TNF alpha blockers and anti-drug antibodies (anti-drug Ab) in patients with rheumatoid arthritis (RA) and spondyloarthritis (SpA) treated with adalimumab (ADA), etanercept (ETA), or infliximab (INF) for a prolonged period of time. Methods. Clinical characteristics (disease activity, and adverse events), serum TNF alpha blockers, and anti-drug Ab levels were evaluated in 62 RA and 81 SpA patients treated with TNF alpha blockers for a median of 28 months. Results. Anti-ADA Ab were detected in 1 (4.0%) and anti-INF Ab in 14 out of 57 (24.6%) RA and SpA patients. Patient with anti-ADA Ab and 57.1% patients with anti-INF Ab were considered nonresponders to treatment. Anti-ETA Ab were not found in any of 61 ETA treated patients. Anti-ADA and anti-INF Ab levels differ between responders and nonresponders (P > 0.05). Three (5.3%) patients with high serum anti-INF Ab levels developed infusion related reactions. Patients with anti-INF Ab more often required changing to another biologic drug (OR 11.43 (95% CI 1.08-120.93)) and treatment discontinuation (OR 9.28 (95% CI 1.64-52.52)). Conclusion. Patients not responding to treatment had higher serumanti-ADAand anti-INFAb concentrations. Anti-INFAb formation is related to increased risk of infusion related reactions, changing to another biologic drug, and treatment discontinuation.