ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 1603

Effect of Methotrexate on the Immunogenicity of TNF Inhibitors in Spondyloarthritis Patients

Alejandro Villalba1, Chamaida Plasencia-Rodriguez1, Diana Peiteado1, Laura Nuño2, Gema Bonilla3, Alejandro Balsa4, Emilio Martín-Mola5 and Dora Pascual-Salcedo6, 1Rheumatology, Hospital La Paz - IdiPaz, Madrid, Spain, 2Hospital La Paz-IdiPaz, Madrid, Spain, 3Rheumatology, Hospital La Paz, Madrid, Spain, 4Reumatology, Hospital Universitario La Paz, Madrid, Spain, 5Rheumatology, Hospital Universitario La Paz, Madrid, Spain, 6Immunology, La Paz University Hospital, Madrid, Spain

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: ,

Session Information

Title: Spondyloarthropathies and Psoriatic Arthritis - Clinical Aspects and Treatment II

Session Type: Abstract Submissions (ACR)

Background/Purpose: The spondyloarthritis (SpA) patients treated under TNF inhibitors (TNFi)  with detectable antidrug antibodies (ADA) often develop  loss of efficacy. Concomitant therapy with  methotrexate (MTX) appears to reduce the the immunogenicity of biological drugs. Our aim was to analyze if the use of combined therapy with MTX and TNFi can reduce the incidence of ADA and whether its effect is MTX dose dependent in SpA patients. 

Methods: In this retrospective observational study, 162 SpA patients (including ankylosing spondylitis, Psoriatic SpA, SpA associated with  inflammatory bowel disease  and undifferentiated SpA) were included. The patients are treated with infliximab (Ifx) or adalimumab (Ada). The presence of ADA were measured at baseline and before each administration by ELISA to complete a follow up of 3 years. The patients were divided in two groups [MTX-15 (dose <15 mg/week) and MTX+15 (≥15 mg/week)] to study the influence of baseline MTX dose on immunogenicity. The statistical analysis was performed using SPSS 11.0.

Results : Eighty nine out of 162 (54,9%) patients were male. Eighty five out of 162 (52,5%) patients received Ifx and 77 out of 162 (47,5%) Ada. The mean duration of treatment was 13.38±9.19 years to Ifx and 12.71±10.46 years for Ada. Forty five patients received MTX weekly at baseline [25/85 (29.4%)in Ifx and 20/77 (26%)in Ada]. The mean dose of MTX was 15,9±4.76 mg/week. Twenty nine out of 162 (17,9%) patients developed ADA,  and ADA presence was significantly higher in SpA patients on Ifx therapy [21/85(24.7%) in Ifx vs 8/77 (10.4%) in Ada, p=0.018)]. The presence of ADA was less frequent in SpA patients taking MTX [3/45 (6.7%) with MTX vs 26/117 (22,2%) without MTX, p=0.022]. No statistically differences were observed in the influence of baseline MTX dose on the ADA appearance (in Ifx: 2/18 (11,1%) in MTX+15 vs 1/9 (11,1%)in MTX-15, p=1,0; in Ada: 1/14 (7,4%) in MTX+15 vs 0/4 (0,0%)in MTX-15, p=1,0).

Conclusion: In this cohort of SpA patients treated with Ifx and Ada, the use of MTX has a preventive effect on the ADA development. However, the baseline MTX dose is not a determinant factor to get this effect. Further prospective studies are needed to confirm these data.

Disclosure:

A. Villalba,
None;

C. Plasencia-Rodriguez,

Pfizer Inc,

2;

D. Peiteado,
None;

L. Nuño,
None;

G. Bonilla,
None;

A. Balsa,

Pfizer Inc,

8,

Amgen,

8;

E. Martín-Mola,

Pfizer Inc,

8,

Abbie,

8,

U.C.B.,

8,

Roche Pharmaceuticals,

8;

D. Pascual-Salcedo,

Pfizer Inc,

2.

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