Monday, June 26, 2017

Immunogenicity and Anti-Drug Antibodies to Biologics at the 2017 EULAR Annual Meeting

ADA (anti-drug antibodies) are probably less of a problem than thought of before - at least in rheumatology. In the discussion during a workshop at the 10th TNF-alpha Forum in Munich (January 2017) [1] we found that ADA are significantly more important in gastroenterology and that gastroenterologists measure ADAs quite regularly. The workshop has been able to answer many questions, but also raised new ones. For example, we have to evaluate how useful measuring ADAs is in rheumatology. Let’s look at the 2017 EULAR Annual Meeting.

A. Gils talked on [2]: “IMMUNOGENICITY OF BIOLOGICS IN INFLAMMATORY BOWEL DISEASES”. Dr. Gils talked about correlations between through concentration of infliximab, adalimumab, golimumab, vedolizumab and clinical outcome. In gastroenterology “optimal therapeutic windows have been defined for both infliximab and adalimumab”. Immunogenicity is the capability of biologicals to elicit non-neutralizing or neutralizing anti-drug antibodies. He concluded: “Combining therapeutic drug concentrations and anti-drug antibody concentrations with relevant patient, disease and drug information will lead to optimal dosing of patients aiming at optimal clinical, biochemical and endoscopic outcomes.”

J.W. Bijlsma gave a talk on [3]: “AS A RHEUMATOLOGIST, DOES IT HAVE ANY CONSEQUENCE IN MY DAILY PRACTICE?” Dr. Bijlsma has no need for measuring ADAs in practice as the “consequences are zero: when the patient is not responding to the given drug anymore, I need to adapt the treatment”. And: “Would the presence of anti-drug antibodies influence my decision? No, there is no cross-reactivity to other biologicals (even from the same class of action), except to its biosimilar (underscoring that it is a real biosimilar!).” With drug-trough levels, it’s another story; these are tested in rheumatology, but it’s too early for a final decision on this topic. He stressed, that “with a look at cost-effectiveness this will certainly become relevant”.

What can we take out of these two talks? Though gastroenterology and rheumatology share the same drugs, our patients have different needs. ADAs in rheumatology are useful in science and need not be measured in daily practice. Drug-trough levels might become a hot topic in individualizing dosage of biologics.

Links and References:
[2] DOI: 10.1136/annrheumdis-2017-eular.7210
[3] DOI: 10.1136/annrheumdis-2017-eular.7118


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