Characteristics of patients who developed transient anti-adalimumab antibodies

Among 190 patients with anti-adalimumab antibodies (AAA), 9.47% experienced transient AAA resolution, which was associated with lower AAA levels and higher adalimumab levels. Therapeutic drug monitoring may guide personalized decisions to continue adalimumab in selected patients.

Osama Elaraby; Dalia El Feky; Çigdem Yaşar; W. Yoo; Anadi Khatri; Dalia Abd Elmegid; Jia-Horung Hung; Battuya Ganbold; Z. Thng; Negin Yavari; Aim-On Saengsirinavin; N. Than; F. A. Añover; A. Hamouda; S. Mohammadi; Irmak Karaca; Amir Akhavanrezayat; A. T. Tran; Jingli Guo; Yue Bai; Q. Nguyen; Christopher Or· Journal of Ophthalmic Inflammation and Infection· 2025· DOI 10.1186/s12348-025-00520-7

The core problem

Adalimumab, a monoclonal antibody targeting tumor necrosis factor alpha (TNF-α), is approved for autoimmune diseases and non-infectious uveitis (NIU). However, immunogenicity can lead to the formation of anti-adalimumab antibodies (AAA), which may reduce therapeutic efficacy and necessitate treatment changes. While persistent AAA often prompts discontinuation, some patients develop transient AAA that resolves over time. This study aimed to describe the clinical characteristics of patients with transient AAA and compare them to those with persistent AAA, testing whether serum antibody and drug levels differ between groups.

Innovation

We conducted a retrospective cohort study using the Stanford Research Repository (STARR) to identify patients treated with adalimumab for autoimmune conditions between June 2006 and May 2024 who developed AAA. Patients whose AAA became undetectable on follow-up testing were compared to an age-, sex-, and disease-matched cohort with persistent AAA. Demographics, diagnoses, treatment details, serum adalimumab and AAA levels, and concomitant immunomodulatory therapy (IMT) were analyzed. Statistical comparisons were performed to assess differences between groups.

Introduction

Adalimumab, a monoclonal antibody targeting tumor necrosis factor alpha (TNF-α), is approved for autoimmune diseases and non-infectious uveitis (NIU). However, immunogenicity can lead to the formation of anti-adalimumab antibodies (AAA), which may reduce therapeutic efficacy and necessitate treatment changes. While persistent AAA often prompts discontinuation, some patients develop transient AAA that resolves over time. This study aimed to describe the clinical characteristics of patients with transient AAA and compare them to those with persistent AAA, testing whether serum antibody and drug levels differ between groups.

Why it matters

The findings suggest that therapeutic drug monitoring of AAA and adalimumab levels can help identify patients with transient AAA who may safely continue treatment. Lower AAA levels and higher adalimumab levels were associated with antibody resolution, indicating that detection of AAA should not automatically lead to discontinuation. Instead, monitoring can guide personalized therapeutic strategies, supporting continued adalimumab use in selected patients. This approach may improve outcomes by maintaining effective treatment while avoiding unnecessary switching.

Who should read this

Praktisi kesehatan, peneliti klinis, dan pembaca Research Digest.

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