Spondyloarthritis & psoriatic arthritis
Prevalence and clinical relevance of anti-drug antibodies in psoriatic arthritis: a systematic review
Authors' conclusion
ADA prevalence in PsA varies widely between bDMARDs and across studies of the same bDMARD. ADAs appear most clinically relevant for TNF inhibitors, whereas evidence for other biological classes remains limited.
Study context
- Population
- Adults with PsA receiving biological disease-modifying antirheumatic drugs (bDMARDs); MEDLINE, Embase and Cochrane CENTRAL searched from inception to September 202528 studies (19 RCTs, 9 observational)
- Outcome
- Prevalence of ADAs in PsA treated with bDMARDs; associations with serum drug levels, clinical efficacy and safety
Methodological detailsPRISMA-guided, randomised controlled trials and observational studies, Risk of bias assessed with Cochrane RoB 2 and ROBINS-I
- PRISMA-guided
- Randomised controlled trials and observational studies
- Risk of bias assessed with Cochrane RoB 2 and ROBINS-I
Pooled result
As reported in the abstract
ADA prevalence
- ADA prevalence varied widely between bDMARDs and across studies of the same drug; not directly comparable due to immunoassay heterogeneity
- Highest ADA prevalence with adalimumab, infliximab and golimumab, followed by ustekinumab, ixekizumab, certolizumab pegol and guselkumab
- Secukinumab and etanercept: very low or absent immunogenicity
Further pooled results
Anti-drug antibodies (ADAs) and drug levels/clinical response with TNFi
- ADAs consistently associated with lower serum drug levels and reduced clinical response
- Concomitant MTX associated with lower ADA prevalence
Drug levels and clinical outcomes with IL-17, IL-12/23 and IL-23 inhibitors
- Data limited or lacking
Original publication
Prevalence and clinical relevance of anti-drug antibodies in psoriatic arthritis: a systematic review. RMD Open. Published 19 August 2026. doi:10.
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