Answer:
The risk of forming neutralizing antibodies, which may result in diminished drug efficacy and increased risk of adverse reactions, varies with the specific type of tumor necrosis factor (TNF)-α inhibitor. The neutralizing antibodies are most commonly reported with use of infliximab and adalimumab, and they have not been reported with etanercept.
Human antichimeric and antihuman antibodies formed in patients treated with infliximab and adalimumab can lead to infusion reactions and local and systemic immune reactions, a reduced duration of response to treatment, and requirements for higher doses or for more frequent dosing intervals, eventually leading to drug failure. Higher levels of antibodies are associated with reduced clinical benefits in a greater number of patients treated with infliximab and adalimumab compared with lower levels.
The formation of antinuclear antibodies, antibodies to double-stranded deoxyribonucleic acid, and antiphospholipid antibodies has been reported in response to all TNF-α inhibitors.
Cases of vasculitis, particularly cutaneous vasculitis, and lupus-like syndromes have been reported in association with TNF-α inhibitor use most of which resolve following discontinuation of the TNF-α inhibitor.
Other autoimmune conditions that may develop in association with TNF-α inhibitor therapy include psoriatic skin lesions, sarcoidosis, antiphospholipid syndrome, uveitis, interstitial lung disease, dermatomyositis (DM) and polymyositis, demyelinating disease, peripheral neuropathies, and autoimmune hepatitis.
References
1. Bendtzen K, Geborek P, Svenson M, et al. Individualized monitoring of drug bioavailability and immunogenicity in rheumatoid arthritis patients treated with the tumor necrosis factor alpha inhibitor infliximab. Arthritis Rheum. 2006;54:3782.
2. Vincent FB, Morand EF, Murphy K, et al. Antidrug antibodies (ADAb) to tumour necrosis factor (TNF)-specific neutralising agents in chronic inflammatory diseases: a real issue, a clinical perspective. Ann Rheum Dis. 2013;72:165.
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