Risk factors for development of anti-adalimumab antibodies in non-infectious uveitis

Abstract

Purpose : The development of anti-adalimumab antibodies (AAA) during adalimumab therapy in patients with non-infectious uveitis (NIU) has been associated with lower circulating drug levels and decreased clinical efficacy. However, there is no consensus among specialists on AAA testing in patients with NIU. The present retrospective case-control study aimed to determine potential risk factors associated with the development of AAA in patients with NIU treated with adalimumab.

Methods : Medical records of patients with NIU who have been receiving adalimumab for at least 12 months and underwent testing for serum AAA were reviewed. Demographics, clinical characteristics, grading of ocular inflammation, and details of previous and concomitant immunomodulatory therapy were compared between patients who were tested AAA positive and AAA negative. Univariate analysis was done to calculate odds ratio (OR) for the various potential risk factors for AAA development.

Results : A total of 21 patients were analyzed (9 AAA positive and 12 AAA negative). Presence of systemic disease was associated with increased odds of AAA development (OR 11.20, 95% CI 1.04-120.36, p=0.02). Anterior chamber inflammation at baseline was associated with increased odds of AAA development (OR 7.50, 95% CI 0.74-75.72, p=0.04), while vitritis and retinal vasculitis were associated with decreased odds (OR 0.06, 95% CI 0.006-0.69, p=0.01 and OR 0.14, 95% CI 0.02-1.03, p=0.03, respectively). History of other anti-tumor necrosis factor (TNF) therapy, such as infliximab or etanercept, did not favor AAA development (OR 1.25, 95% CI 0.22-7.08, p=0.40), but a history of interruption in anti-TNF therapy (including adalimumab) prior to starting adalimumab or during adalimumab therapy conferred the highest increased odds (OR 40.0, 95% CI 3.05-524.83, p=0.002). Weekly dosing of adalimumab was shown to decrease odds of AAA development as compared to the every 2 weeks regimen (OR 0.10, 95% CI 0.01-1.00, p=0.03), while concomitant anti-metabolite therapy was not shown to be a protective factor (OR 1.25, 95% CI 0.22-7.08, p=0.40).

Conclusions : The presence of underlying systemic disease and history of interruption in anti-TNF therapy were associated with increased odds of AAA development. Identification of patients with higher risk of developing AAA may be useful in clinical decision making to optimize therapeutic outcomes.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.