Ocular inflammation tied to AAA formation in patients with autoimmune disorders

In patients with autoimmune disorders, ocular inflammation appears to increase the risk of anti-adalimumab antibodies (AAA) development, suggests a study.

The authors identified eligible participants using the Stanford Research Repository database. A total of 704 patients treated with adalimumab for autoimmune conditions for at least 6 months and tested for adalimumab levels, AAA, or both were included in the analysis.

The authors collected demographic data, systemic diagnoses, ocular involvement, and prior and concurrent treatment. They also identified factors associated with AAA formation through univariable and multivariable logistic regression analyses.

Of the eligible patients, 151 (21.5 percent) had AAA. The AAA-positive group was predominantly female compared with the AAA-negative group (60.9 percent vs 47.0 percent; adjusted odds ratio [aOR], 1.75, 95 percent confidence interval [CI], 1.07‒2.85; p=0.024).

Multivariable analysis revealed the consistent and independent association of ocular inflammation (aOR, 2.19, 95 percent CI, 1.19‒4.02; p=0.011), female sex (aOR, 1.75, 95 percent CI, 1.08‒2.85; p=0.024), and adalimumab interruption (aOR, 1.74, 95 percent CI, 1.03‒2.94; p=0.038) with an increased risk of AAA development.

Prior biologic therapy other than tumour necrosis factor (TNF)-α inhibitors offered protection against AAA development (aOR, 0.27, 95 percent CI, 0.08‒0.98; p=0.046), whereas prior TNF-α inhibitor use contributed to the risk (aOR, 2.11, 95 percent CI, 1.25‒3.55; p=0.005).

“[P]rospective studies are needed to determine whether this [association] reflects a mechanistic relationship and whether therapeutic drug monitoring in this subgroup improves clinical outcomes,” the authors said.