Rheumatology, Department of Internal Medicine, Sapienza University of Rome, Rome, Italy.
Clin Exp Rheumatol. 2013 Nov-Dec;31(6):954-63. Epub 2013 Aug 26.
Despite the significant advantages in clinical practice associated with TNF-inhibitors, a loss of response over time is sometimes observed, in some cases possibly due to immunogenicity, i.e. the development of antibodies direct against the drug. This review evaluates the immunogenicity of different anti-TNF agents, and discusses its effects on efficacy and safety. Available evidence indicates that all anti-TNF drugs may induce an immune response. However, the variation in the occurrence of anti-drug antibodies, as well as the variation in the impact of antibodies on the efficacy and safety, can be explained by drug conformation itself, use of concomitant immunosuppressants and differences in dosing regimen and route of administration. The association between the development of anti-drug antibodies and low drug serum concentrations is clinically relevant since it is likely related to low response. Strict monitoring of neutralising antibodies might be useful for tailoring therapeutic strategy. There is no evidence of cross-reactivity among different drugs: immunogenicity (the development of specific anti-drug antibodies to one TNF inhibitor) does not seem to affect the effectiveness of another anti-TNF agents; therefore, switching to another drug of the same class might be effective in patients who have developed anti-drug antibodies to a TNF inhibitor.
尽管 TNF 抑制剂在临床实践中有显著优势，但随着时间的推移，有时会观察到疗效丧失，在某些情况下可能是由于免疫原性，即针对药物产生的抗体。本文评价了不同抗 TNF 药物的免疫原性，并讨论了其对疗效和安全性的影响。现有证据表明，所有抗 TNF 药物都可能引起免疫反应。然而，抗药物抗体的发生差异，以及抗体对疗效和安全性的影响差异，可以用药物构象本身、同时使用免疫抑制剂以及剂量方案和给药途径的差异来解释。抗体与低药物血清浓度的相关性具有临床意义，因为它可能与低反应有关。严格监测中和抗体可能有助于调整治疗策略。不同药物之间没有交叉反应的证据：免疫原性（对一种 TNF 抑制剂产生特定的抗药物抗体）似乎不会影响另一种抗 TNF 药物的有效性；因此，对于已经对 TNF 抑制剂产生抗药物抗体的患者，改用同种类的另一种药物可能是有效的。
