The presence or absence of antibodies to infliximab or adalimumab determines the outcome of switching to etanercept

• Published in: Annals of the rheumatic diseases Vol. 70; no. 2; pp. 284 - 288
• Main Authors: Jamnitski, Anna, Bartelds, Geertje M, Nurmohamed, Michael T, van Schouwenburg, Pauline A, van Schaardenburg, Dirkjan, Stapel, Steven O, Dijkmans, Ben A C, Aarden, Lucien, Wolbink, Gerrit Jan
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and European League Against Rheumatism 01.02.2011; BMJ Publishing Group; Elsevier Limited
• Subjects: Adalimumab; Adult; Aged; Antibodies, Monoclonal - immunology; Antibodies, Monoclonal - therapeutic use; Antibodies, Monoclonal, Humanized; Antirheumatic Agents - immunology; Antirheumatic Agents - therapeutic use; Arthritis, Rheumatoid - drug therapy; Arthritis, Rheumatoid - immunology; Autoantibodies - blood; Biological and medical sciences; Biomarkers - blood; Crohn's disease; Diseases of the osteoarticular system; Drug dosages; Drug Monitoring - methods; Epidemiologic Methods; Etanercept; Female; Humans; Immunoglobulin G - therapeutic use; Immunoglobulins; Immunomodulators; Infliximab; Male; Medical sciences; Middle Aged; Patients; Pharmacology. Drug treatments; Receptors, Tumor Necrosis Factor - therapeutic use; Rheumatology; TNF inhibitors; Treatment Failure; Treatment Outcome; Tumor Necrosis Factor-alpha - antagonists & inhibitors; Tumor necrosis factor-TNF; Immunomodulator; Prognosis; Etanercept; Infliximab; Antibody; Antipsoriatic agent; Rheumatology; Immunosuppressive agent; Adalimumab
• ISSN: 0003-4967; 1468-2060; 1468-2060
• DOI: 10.1136/ard.2010.135111

Objective The aim of this study was to test the hypothesis that the reason for non-response (caused by immunogenicity or not) to a first tumour necrosis factor (TNF) inhibitor defines whether a second TNF inhibitor will be effective. Methods This cohort study consisted of 292 consecutive patients with rheumatoid arthritis (RA), all treated with etanercept. A total of 89 patients (30%) were treated previously with infliximab or adalimumab (‘switchers’), and the remaining 203 (70%) were anti-TNF naive. All switchers were divided into two groups: with and without antibodies against the previous biological. Differences in clinical response to etanercept between switchers with and without antibodies and patients who were anti-TNF naive were assessed after 28 weeks of treatment using changes in Disease Activity Score in 28 joints (DAS28). Results After 28 weeks of treatment, response to etanercept did not differ between patients who were anti-TNF naive and switchers with anti-drug antibodies (ΔDAS28=2.1±1.3 vs ΔDAS28=2.0±1.3; p=0.743). In contrast, switchers without anti-drug antibodies had a diminished response to etanercept treatment compared to patients who were TNF naive (ΔDAS28=1.2±1.3 vs ΔDAS28=2.1±1.3; p=0.001) and switchers with antibodies (ΔDAS28=1.2±1.3 vs ΔDAS28=2.0±1.3; p=0.017). Conclusion Patients with RA with an immunogenic response against a first TNF-blocking agent had a better clinical response to a subsequent TNF blocker compared to patients with RA without anti-drug antibodies. Hence, determining immunogenicity can be helpful in deciding in which patient switching could be beneficial and can be part of a personalised treatment regimen.