Immunogenicity of biologic agents in rheumatoid arthritis patients: lessons for clinical practice.
Anti-drug antibodies (ADAbs) develop in up to a third of patients treated with biologic agents, with such immunogenicity being one of the main reasons for the loss of efficacy observed in an important proportion of patients treated with such agents. The appearance of ADAbs has consequences in terms of efficacy and tolerance of the biodrug: the development of ADAbs is associated with a poorer clinical response and with an increased risk of adverse effects. Formation of ADAbs has been observed with all biologic DMARDs, but anti-TNF agent mAbs appear to be the largest contributors, independent of humanization of the antibody. ADAb identification is technically difficult and not standardized, partly explaining important variations between published studies. A variety of factors can influence the risk of ADAb appearance, some of which are linked to the treatment strategy, such as the combination with synthetic DMARDs or the rhythm of administration of the biodrug, whereas other factors are dependent on the patient, such as the level of inflammation at onset or body weight. The detection of these antibodies and/or the dosage of the biologic agent itself could have consequences for the bedside practice of clinicians and should be well understood. This review of the literature proposes an overview of the data published on the subject to help clinicians manage the biodrugs according to these new concepts.
Département de Rhumatologie, Hôpital Pellegrin, CHU de Bordeaux, Unité sous Contrat, Infections à Mycoplasmes et à Chlamydia chez l'Homme, thierry.schaeverbeke@chu-bordeaux.fr.
Thierry
T
Schaeverbeke
Département de Rhumatologie, Hôpital Pellegrin, CHU de Bordeaux, UMR-CNRS 5164 and.
Marie-Elise
ME
Truchetet
Département de Rhumatologie, Hôpital Pellegrin, CHU de Bordeaux.
Marie
M
Kostine
Département de Rhumatologie, Hôpital Pellegrin, CHU de Bordeaux.
Thomas
T
Barnetche
Département de Rhumatologie, Hôpital Pellegrin, CHU de Bordeaux, Laboratoire de Thérapeutique, Université Bordeaux Segalen, Bordeaux, France.
Bernard
B
Bannwarth
Département de Rhumatologie, Hôpital Pellegrin, CHU de Bordeaux, UMR-CNRS 5164 and.
Christophe
C
Richez
D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000276:immunology; D015551:Autoimmunity / Q000276:immunology*; D001685:Biological Factors / Q000627:therapeutic use*; D006801:Humans; D017410:Practice Guidelines as Topic
D001685:Biological Factors
adalimumab; anti-TNF; anti-drug antibody; biodrug; biologic agents; etanercept; immunogenicity; infliximab; methotrexate; rheumatoid arthritis