ANTI-INFLIXIMAB ANTIBODIES AS A MARKER OF DRUG SURVIVAL AND TAPERING IN ANKYLOSING SPONDYLITIS PATIENTS: 12 YEARS FOLLOW-UP
Authors: Clarissa Pimentel et al.
The formation of anti-drug antibodies in patients treated with TNF-inhibitors is associated with an increased risk for treatment failure. This study assessed the frequency and effects of anti-infliximab antibodies (anti-IFX) on drug survival, treatment failure and switch of therapy in a cohort of 60 patients with ankylosing spondylitis. Anti-IFX were detected in 45% of the patients during the follow-up, 85% of these were already detected after 1 year. When patients were concomitantly treated with methotrexate anti-IFX were only detected in 18%. Anti-IFX was associated with shorter drug survival and higher treatment failure. Interestingly, patients that switched therapy had a better chance to have a good clinical response to a second anti-TNF if they had anti-IFX at time of switch.
This study with a long follow up of 12 years confirms previous studies that reported an association of anti-drug antibodies with treatment failure. However, the presence of anti-IFX in patients in patients switching therapy predicts a good response to a second TNF-inhibitor. Concomitant methotrexate clearly reduced the risk for anti-IFX formation and as a result may also reduce the risk of treatment failure. Therefore, in patients that have failed previous treatment with bDMARDs and therapy with infliximab is initiated, a combination with methotrexate can be considered to increase drug survival of infliximab.