Antibodies to Adalimumab?

[Milliebell1]

I've just developed antibodies is this normal? I now have to switch to inflixumad and am worried that I'll develpo antibodies and run out of medicine that can help me.

[Legomum]

I was warned it can happen within 18 months on the anti-TNF drugs. I had to switch from Infliximab to Humira. I am on a low dose of mercaptopurine to reduce the risk of developing them.

“All biological agents (whether of entirely human origin, chimeric, or “humanized”) can cause an immune response, leading to the formation of antidrug antibodies (ADAbs), which are also known as human antichimeric antibodies or human antihuman antibodies, depending on the nature of the drug. The generation of ADAbs is increasingly recognized as a mechanism explaining the failure of anti-TNF drugs in chronic inflammatory diseases. The lack of a clinical response in patients with ADAbs may be due to the formation of an immune complex between TNF inhibitors and ADAbs that suppresses the drug and restricts its therapeutic activity.”

[Milliebell1 in reply to Legomum]

Thank you so much for your reply. How are you getting on with the Humira v inflixumab? Do you notice much of a difference between the two?

[Legomum in reply to Milliebell1]

Humira is easy as can give injection myself at home every 2 weeks rather than the trek to hospital for an infusion. It is controlling the Behçet’s well.

[Milliebell1 in reply to Legomum]

Yes thats why I liked it too. Oh well I'll just have to deal with the infusions now! I wonder if theres weight in taking azohiaprine as well to prevent anti bodies forming

[Legomum in reply to Milliebell1]

Ask your team what they recommend as my doctors looked at mercaptopurine and another option MMF as I had been on Azathioprine in the past and that was no longer helping me.

Rheumatologists have published lots of research about the use of anti-TNF biologics in Rheumatoid Arthritis (RA) and combining with a drug to prevent the antibodies forming as they have been using biologics for longer and with far more patients than a rare disease like Behçet’s. Example pasted below:

One of the important studies was the “ATTRACT study”, which evaluated three ascending doses of infliximab, alone or in combination with MTX (methotrexate) to decrease the immunogenicity of the biologic agent. In that historical study, Maini et al. showed an inverse relationship between administered doses and ADAb production and a preventive effect of the combination with MTX: anti-infliximab antibodies were observed in, respectively, 53%, 21% and 7% of patients receiving 1, 3 and 10 mg/kg of infliximab alone, vs 15%, 7 and 0% of patients receiving the same infliximab regimens in combination with MTX. That study suggested the potential role of immunogenicity in response failure to biologic therapies in RA.