Pichi Francesco, AlAli Sahar H, Jimenez Yanny Perez, Neri Piergiorgio
From the Eye Institute, Cleveland Clinic Abu Dhabi (F.P., S.H.A., Y.P.J., P.N.), Abu Dhabi, United Arab Emirates; Cleveland Clinic Lerner College of Medicine (F.P., P.N.), Case Western Reserve University, Cleveland, Ohio, USA.
From the Eye Institute, Cleveland Clinic Abu Dhabi (F.P., S.H.A., Y.P.J., P.N.), Abu Dhabi, United Arab Emirates.
Am J Ophthalmol. 2025 Mar;271:381-388. doi: 10.1016/j.ajo.2024.12.009. Epub 2024 Dec 17.
Adalimumab, a TNF-alpha inhibitor, is the only FDA-approved biologic for non-infectious uveitis (NIU). However, treatment responses vary, potentially due to interindividual pharmacokinetic differences influenced by body mass index (BMI). This study aimed to evaluate the impact of BMI on adalimumab serum trough levels and therapeutic efficacy in patients with NIU.
Cross-sectional, clinical study.
Setting: Single-center study. - Study Population: 80 patients with NIU treated with Adalimumab - Observation Procedure: Adalimumab serum trough levels and anti-Adalimumab antibody (AAA) levels were measured. BMI was calculated at treatment initiation, and patients were categorized into normal weight, overweight, obese, and morbidly obese groups. - Main Outcome Measures: The correlation between BMI, adalimumab levels, and clinical response was analyzed using Pearson correlation, chi-square tests, and logistic regression.
Higher BMI was associated with lower adalimumab serum levels and a reduced likelihood of clinical response. A significant negative correlation was found between BMI and adalimumab levels (r = -0.408, P = .007). Logistic regression identified BMI as a significant predictor of treatment response (P = .017). A BMI threshold of 26.4 was identified, above which the probability of a positive response significantly decreased. Additionally, 51.2% of patients were non-responders, all of whom demonstrated detectable AAA.
Higher BMI is associated with lower adalimumab trough levels and reduced treatment efficacy in NIU patients. A BMI threshold of 26.4 may serve as a clinical marker for tailoring adalimumab therapy, highlighting the need for personalized dosing strategies in patients with elevated BMI.
阿达木单抗是一种肿瘤坏死因子-α抑制剂，是唯一获美国食品药品监督管理局批准用于治疗非感染性葡萄膜炎（NIU）的生物制剂。然而，治疗反应存在差异，这可能是由于体重指数（BMI）影响个体间的药代动力学差异所致。本研究旨在评估BMI对NIU患者阿达木单抗血清谷浓度及治疗效果的影响。
横断面临床研究。
地点：单中心研究。 - 研究人群：80例接受阿达木单抗治疗的NIU患者 - 观察程序：测定阿达木单抗血清谷浓度及抗阿达木单抗抗体（AAA）水平。在治疗开始时计算BMI，并将患者分为正常体重、超重、肥胖和病态肥胖组。 - 主要观察指标：使用Pearson相关性分析、卡方检验和逻辑回归分析BMI、阿达木单抗水平与临床反应之间的相关性。
较高的BMI与较低的阿达木单抗血清水平及临床反应可能性降低相关。BMI与阿达木单抗水平之间存在显著负相关（r = -0.408，P = .007）。逻辑回归分析确定BMI是治疗反应的显著预测因素（P = .017）。确定了BMI阈值为26.4，高于此值时阳性反应的概率显著降低。此外，51.2%的患者无反应，所有这些患者均检测到可检测的AAA。
较高的BMI与NIU患者较低的阿达木单抗谷浓度及治疗效果降低相关。BMI阈值26.4可作为调整阿达木单抗治疗的临床标志物，突出了BMI升高患者采用个性化给药策略的必要性。
