Response to Biologic Drugs in Patients With Rheumatoid Arthritis and Antidrug Antibodies
Main finding · EULAR responseResult — go to the resultOdds ratio 0.19 95% CI 0.09–0.38Authors' conclusion
Results of this prospective cohort study suggest an association between antidrug antibodies and nonresponse to bDMARDs in patients with RA.
Study context
- Population
- Patients ≥18 years with rheumatoid arthritis (RA) initiating a new bDMARD (adalimumab, infliximab, etanercept, tocilizumab or rituximab), 27 centres in France, Italy, the Netherlands and the UK, 2014–2016 (ABI-RA)230 analysed
- Participants
- 254 patients
- Exposure
- Antidrug antibody positivity vs negativity in patients initiating a new bDMARD
- Outcome
- Association of antidrug antibody positivity with EULAR response to treatment
- Follow-up
- Month 12
Methodological detailsmulticentric, open, univariate logistic regression, generalized estimating equation models
- Multicentric
- Open
- Univariate logistic regression
- Generalized estimating equation models
Main finding
EULAR response
Odds ratio
0.19
95% CI 0.09–0.38
P < 0.001
Antidrug antibody-positivevs Antidrug antibody-negative
OR 0.19 (95% CI 0.09–0.38); P < 0.001
As reported in the abstract
Observational data: associations, not effects.
Secondary outcomes
| Outcome | OR (95% CI) | P value | |
|---|---|---|---|
| EULAR response, all visits from month 6 (generalized estimating equation models) · month 6 to months 15 to 18 | 0.35 (0.18–0.65) | P < 0.001 | |
| 0.20.5125Odds ratio (log scale) |
| Outcome | Mean difference (mg/L) (95% CI) | P value | |
|---|---|---|---|
| Drug concentration of anti-TNF mAbs | −9.6 (−12.4 to −6.9) | P < 001 | |
| −15−10−505Difference, mg/L (linear scale) |
EULAR response, tocilizumab alone
- Similar inverse association between antidrug antibody positivity and EULAR response for tocilizumab alone
- OR, 0.18; 95% CI, 0.04-0.83; P = .03
Antidrug antibody positivity by drug · month 12
- Anti-TNF mAbs
- 38.2%
- Etanercept
- 6.1%
- Rituximab
- 50.0%
- Tocilizumab
- 20.0%
Factors associated with response (multivariable analysis)
- Antidrug antibodies, BMI and RF independently inversely associated with response to treatment
Drug concentrations, nonresponders vs responders
- Etanercept concentration lower in nonresponders vs responders (mean difference, mg/L)
- 0.70 [95% CI, 0.2-1.2]; P = .005
- Adalimumab concentration lower in nonresponders vs responders (mean difference, mg/L)
- 1.8 [95% CI, 0.4-3.2]; P = .01
MTX comedication at baseline and antidrug antibodies
- MTX comedication inversely associated with antidrug antibodies
- OR, 0.50; 95% CI, 0.25-1.00; P = .05
Original publication
Response to Biologic Drugs in Patients With Rheumatoid Arthritis and Antidrug Antibodies. JAMA Netw Open. Published 3 July 2023. doi:10.
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