A new study proves what many suspected – that Rheumatoid Arthritis patients develop antibodies against adalimumab (Humira) which lessen the effectiveness of the drug. Previous studies have shown this to be true for other Biologic treatments as well.
Anti-adalimumab antibodies: another front in our battle against RA
Doctors in the Netherlands found 28% of patients developed antibodies to Humira (adalimumab), most of them (67%) within the first few months of treatment. They measured serum adalimumab concentrations and “antiadalimumab” antibodies and found that patients who developed the antibodies had lower serum concentration of adalimumab (that means less Humira) in their bodies. They concluded that “the development of antidrug antibodies was associated with lower adalimumab concentration and lower likelihood of minimal disease activity or clinical remission.”
The report, Development of Antidrug Antibodies Against Adalimumab and Association With Disease Activity and Treatment Failure During Long-term Follow-up, followed 272 patients for three years. One of the most dramatic factors was the lowered likelihood of achieving minimal disease activity (or clinical remission) in patients who developed the antibodies against Humira:
“Ninety-five of 196 patients (48%) without antiadalimumab antibodies had minimal disease activity vs 10 of 76 patients (13%) with antiadalimumab antibodies; patients with antiadalimumab antibodies less often had sustained minimal disease activity score in 28 joints (DAS28) (< 3.2; HR, 3.6; 95% CI, 1.8-7.2; P < .001) compared with antiadalimumab antibody–negative ones. Three of 76 patients (4%) with antiadalimumab antibodies achieved sustained remission compared with 67 of 196 (34%) antiadalimumab antibody–negative ones; patients with antiadalimumab antibodies less often achieved remission (DAS28 < 2.6; HR, 7.1; 95% CI, 2.1-23.4; P < .001) compared with antiadalimumab antibody–negative ones.”
What patients know about adalimumab treatment failure
1) Many don’t respond to Biologics anyway.
For many patients, blocking TNF-alpha doesn’t improve RA symptoms. As I read a lot of press reports of this study, this fact was not mentioned. I’m just tired of reading and hearing everywhere the assumption that Biologics work on all patients until they eventually stop working. The treatments we have today don’t work at all in at least 1/3 of patients. And most people who do “respond” still live with symptoms of RA since a good response is often no more than twenty to fifty percent improvement.
2) Methotrexate can help avoid antibodies.
Only 4% of patients with antibodies to Humira “achieved remission,” compared with 34% of those without antibodies. So part of the game of RA treatment is to avoid creating antibodies that can neuter the treatment. Patients who also took methotrexate were less likely to develop the antibodies since methotrexate suppresses the immune system.
Of course patients hope new treatments can be created that can out-smart our immune systems completely, preventing antibodies from developing. Evidently, that’s more difficult than many of us can visualize.
- Which Biologic Treatment Should RA Patients Try Next?
- How Soon Should You Switch Biologics for Rheumatoid Arthritis?
- Cost effectiveness: News about Rheumatoid Arthritis Treatment Options
- Side by side: Comparison of Biologics for Rheumatoid Arthritis (RA)
- How well do Biologic medications help Rheumatoid Arthritis?