Abstract
Purpose :
Anti-drug antibodies (ADA) may form against adalimumab when it is used to treat autoimmune conditions. ADA may reduce the effectiveness of adalimumab when used in patients with non-infectious uveitis. We performed an observational cross-sectional cohort study to determine the prevalence of ADA in patients with non-infectious uveitis.
Methods :
Consecutive adult patients receiving adalimumab for non-infectious uveitis at either the Royal Victorian Eye and Ear Hospital, or Eye Surgery Associates in Melbourne, Australia were recruited from March 2023 to August 2023. All patients were tested for serum trough adalimumab level, and adalimumab ADA. Clinical data were collected via chart review.
Results :
We recruited 70 patients (37 females) with median age 45 years (range 19, 87). All forms of uveitis were evenly represented [anterior uveitis (N=17), intermediate uveitis (N=16), posterior uveitis (N=16) and panuveitis (N=21)]. Most patients had bilateral uveitis (N=65). Median duration of uveitis was 5.1 years (range 0.2-25.3) and median duration of adalimumab therapy was 2.3 years (range 0.2-12.5). The most common diagnoses were idiopathic uveitis (N=22), sarcoidosis (N=12) and Vogt-Koyanagi-Harada disease (N=6). The majority (N=56) received 40mg adalimumab fortnightly, and 40 were concurrently treated with conventional immunosuppression (e.g. methotrexate).
ADA was present in 5 of 70 patients (7%). Compared to patients without ADA, patients with ADA had lower serum adalimumab levels [median 0.0 µg/mL (IQR 0.0, 0.0) vs 5.6 µg/mL (IQR 2.8, 8.2), p=0.003], higher C-reactive protein [median 7.4 mg/L (IQR 5.5, 7.9) vs 2.0 mg/L (IQR 0.0, 5.8), p=0.033], were less likely to have bilateral uveitis (60% vs 95%, p=0.038), and scored lower on a patient-reported measure of health [median 5/10 (IQR 5, 6) vs 8/10 (IQR 6, 8), p=0.027]. We found no associations with sex, duration of therapy, presence of systemic inflammatory disease, or use of concurrent conventional immunosuppression. We found no statistically significant differences in uveitis activity, visual acuity, or side effects to adalimumab.
Conclusions :
We found a low prevalence of ADA against adalimumab in our cohort. Presence of ADA was associated with reduced serum drug levels, higher C-reactive protein, unilateral uveitis, and worse patient-reported health. Presence of ADA was not associated with systemic inflammatory disease, uveitis activity nor adalimumab monotherapy.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.