Efficacy of tumor necrosis factor-α inhibitors in the treatment of various immunoinflammatory diseases: focus on immunogenicity

In clinical practice, differences in the efficacy of tumor necrosis factor-α inhibitors (iTNF-α) have been observed in different diseases.Objective: to evaluate the efficacy of iTNF-α in patients with immune-mediated diseases and its relation to the immunogenicity of these drugs.Material and methods. The study included 70 patients with rheumatic diseases (RD) and 53 with inflammatory bowel disease (IBD) treated with infliximab (IFN), adalimumab, or certolizumab pegol (CZP). Disease activity and response to therapy were evaluated, as well as measurement of the minimal residual concentration of iTNF-α and the level of anti-drug antibodies.Results and discussion. Therapy efficacy was maintained in 60 (85.7%) patients with RD and 35 (66.0%) with IBD (odds ratio, OR 1.3; p=0.01). Event-free survival of therapy was observed more frequently in RD and was longer than in IBD (p<0.01). The incidence of treatment failure was 3.13 times higher in IBD than in RD (p<0.01). In contrast to IBD, low TNF-α levels were more common in RD patients who did not respond to treatment than in those who did (80% and 40%, respectively; OR 6.0; p<0.05). Anti-TNF-α antibodies were detected in 75% of patients with ineffective treatment with INF and CZP in the RD group and in 14.3% in the IBD group (OR 0.06; p<0.05).Conclusion. In patients with RD, the effect of iTNF-α lasted more frequently and longer than in patients with IBD. In ankylosing spondylitis and rheumatoid arthritis, the ineffectiveness of iTNF-α was associated with the formation of anti-drug antibodies or their low concentration in most cases, but in IBD only in half of the cases.