Some patients who receive treatment with biologics may develop antidrug antibodies (ADA), which are thought to be a possible cause behind poor clinical response to biologics. A poster abstract presented at American Academy of Dermatology Virtual Meeting Experience 2021 found that cellular lineage and nomenclature were poor indicators of ADA development and clinical efficacy.

A literature review of clinical trials and postmarketing registry data, including adalimumab, infliximab, etanercept, certolizumab pegol, golimumab, ustekinumab, tildrakizumab, guselkumab, risankizumab, secukinumab, ixekizumab, and brodalumab, was conducted across PubMed, Medline, and Embase. A total of 36 studies met the inclusion criteria–at least 15 patients, use of the Psoriasis Area and Severity Index (PASI), and information on ADA–out of the 41 studies selected from the databases.

Of the studies selected, golimumab and tildrakizumab were excluded due to a lack of studies that met the inclusion criteria. Adalimumab had four studies; secukinumab had seven studies; ustekinumab had six studies; brodalumab and certolizumab had one study each; guselkumab, risankizumab, and ixekizumab had two studies each; infliximab had eight studies; and etanercept had five studies.

In fully human monoclonal antibodies, six of the seven trials for secukinumab did not detect ADA formation, but all four of the adalimumab studies detected ADA formation. Additionally, ADA formation was associated with a worse clinical response as well as significantly lower serum trough levels. However, these lower serum trough levels did not preclude a clinical response. The type of biologic–fully human, humanized, or chimeric monoclonal antibody–had no correlation with immunogenicity.

Ultimately, the cellular lineage and nomenclature of biologics used to treat psoriasis are not predictors of ADA development and clinical efficacy. The authors recommend selecting biologic agents individually for each patient, based upon their clinical efficacy and safety profile. —Audrey Amos, PharmD

Reference
Gao J, Dorelien D, Cline A, Safai B. Anti-drug antibody formation with use of biological agents in psoriasis patients. Poster presented at: American Academy of Dermatology Virtual Meeting Experience 2021; April 23-25, 2021; virtual.