Abstract
Purpose :
Anti-adalimumab antibody (AAA) has altered the care of patients receiving adalimumab (ADA) treatment. Furthermore, a certain group of patients with initial positive AAA (AAA+) was found to later test negative for AAA (AAA-) following cessation of ADA. This study aims to explore this cohort for its clinical significance.
Methods :
One hundred and twenty-one consecutive patients receiving ADA therapy with a subsequent AAA+ and cessation of ADA therapy were enrolled into our study from December 2017 to August 2023. Demographic and clinical data of this cohort, including the clinical diagnosis, serum ADA levels, and ophthalmic examination were reviewed. The subjects with a subsequent negative AAA titer (AAA-) were identified and analyzed. A 1:1 age-sex matched cohort of patients with persistent AAA+ was used to compare the clinical features.
Results :
Of the 121 AAA+ patients, 9 patients (7.4%) became AAA- during follow-up. Mean duration from AAA+ to AAA- was 50.3±34.7 weeks. Mean follow-up time of 77.3±32.7 months. Only 14 out of 121 (11.6%) patients received at least two AAA assessments. The mean age of the patients was 24.0±21.2 years, and 2 of the 9 patients were female. Most common systemic disease in this cohort were Crohn’s disease (33%) and ulcerative colitis (22%). Two (22%) patients had controlled uveitis with excellent visual acuity. The mean duration of ADA use until AAA+ was 36.7±24.6 weeks. Interestingly, the ADA blood level of AAA+ patients which later became AAA- trended to be higher than those with persistent AAA+ (5.4±4.4 vs 2.8±2.8 mcg/mL, p = 0.16). Most common systemic therapies were methotrexate (44%) and steroids (44%). No relationships were observed between ADA levels, duration from AAA+ to AAA-, age of disease onset, age of ADA use, duration of ADA use until AAA+, and ADA blood level when AAA+ (Pearson’s correlation r= 0.006, 0.048, -0.102, -0.276, p-value=0.99, 0.90, 0.78, and 0.44, respectively).
Conclusions :
Overall, about 7% of AAA+ patients became AAA- during follow-up. Interestingly, the initial ADA blood level of AAA+ patients which later became negative trended to be higher than those with persistent AAA+. Further studies are required. Our study may provide basis for additional AAA assessment should ADA therapy be reconsidered following AAA positivity and ADA treatment cessation.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.