The British journal of ophthalmology · 2026
Single-centre observational study of anti-adalimumab antibody development in children and young people treated for juvenile idiopathic arthritis and/or non-infectious uveitis.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Wilson Charlotte Rose, Somerville Scott Robert, Hawley Daniel P, Choi Jessy
Аннотация
BACKGROUND: Adalimumab is an effective first-line biologic therapy used to treat children and young people (CYP) with juvenile idiopathic arthritis (JIA) and non-infectious uveitis (NIU). However, the development of neutralising antibodies may compromise adalimumab's efficacy. This study investigated the incidence and clinical relevance of anti-adalimumab antibody (AAA) development in CYP treated with adalimumab for JIA and/or NIU.
METHODS: A retrospective observational study was conducted within a specialist paediatric rheumatology service at a tertiary UK centre. CYPs receiving adalimumab between January 2015 and January 2024 who were tested for AAAs were included. Outcome measures included AAA positivity rate, serum drug levels, concurrent disease-modifying anti-rheumatic drug (DMARD) use, timing of antibody development and patient outcomes following AAA results.
RESULTS: Among 390 CYP treated with adalimumab, 112 were tested for AAAs (156 total tests). Overall, 41.0% were AAA positive (>10 mg/L). All CYP with sub-therapeutic drug levels (<3 mg/L) were AAA positive. AAA positivity was higher in CYP not receiving concurrent DMARDs (52.4%) compared with those receiving full-dose methotrexate (21.1%) (OR 4.12, p=0.002). Among AAA-positive patients, 53.1% discontinued adalimumab treatment versus 15.2% of AAA-negative patients (OR 6.3, p<0.0001). Serial testing revealed fluctuating AAA levels, including reductions following corticosteroid use.
CONCLUSIONS: High AAA incidence was observed in CYP with JIA and NIU, with most tested during disease flare. AAA positivity correlated with sub-therapeutic drug levels and treatment discontinuation, particularly in the absence of concurrent full-dose methotrexate. Short-term variability in antibody titres suggests that a single positive result may not reliably indicate treatment failure.
METHODS: A retrospective observational study was conducted within a specialist paediatric rheumatology service at a tertiary UK centre. CYPs receiving adalimumab between January 2015 and January 2024 who were tested for AAAs were included. Outcome measures included AAA positivity rate, serum drug levels, concurrent disease-modifying anti-rheumatic drug (DMARD) use, timing of antibody development and patient outcomes following AAA results.
RESULTS: Among 390 CYP treated with adalimumab, 112 were tested for AAAs (156 total tests). Overall, 41.0% were AAA positive (>10 mg/L). All CYP with sub-therapeutic drug levels (<3 mg/L) were AAA positive. AAA positivity was higher in CYP not receiving concurrent DMARDs (52.4%) compared with those receiving full-dose methotrexate (21.1%) (OR 4.12, p=0.002). Among AAA-positive patients, 53.1% discontinued adalimumab treatment versus 15.2% of AAA-negative patients (OR 6.3, p<0.0001). Serial testing revealed fluctuating AAA levels, including reductions following corticosteroid use.
CONCLUSIONS: High AAA incidence was observed in CYP with JIA and NIU, with most tested during disease flare. AAA positivity correlated with sub-therapeutic drug levels and treatment discontinuation, particularly in the absence of concurrent full-dose methotrexate. Short-term variability in antibody titres suggests that a single positive result may not reliably indicate treatment failure.