Pediatr Gastroenterol Hepatol Nutr.  2018 Oct;21(4):329-335. 10.5223/pghn.2018.21.4.329.

Reversal of Immunogenicity in Pediatric Inflammatory Bowel Disease Patients Receiving Anti-Tumor Necrosis Factor Medications

• Kang E
• Khalili A
• Splawski J
• Sferra TJ
• Moses J

• KMID: 2421996
• DOI: http://doi.org/10.5223/pghn.2018.21.4.329

Abstract

Loss of response to anti-tumor necrosis factor (anti-TNF) agents in the treatment of inflammatory bowel disease (IBD) is a major consideration to maintain sustained response. Reversal of immunogenicity can re-establish response and increase the durability of these agents. Strategies to reverse immunogenicity include dose-intensification and/or the addition of an immunomodulator. However, there is a relative paucity of data on the efficacy of such interventions in pediatric IBD patients. Available reports have not strictly utilized homogenous mobility shift assay, which reports on anti-drug antibodies even in the presence of detectable drug, whereas prior studies have been confounded by the use of drug sensitive assays. We report four pediatric inflammatory bowel disease patients with successful reversal of immunogenicity on an anti-TNF agent using dose intensification and/or addition of an immunomodulator.

Keyword

Child; Biological products; Antibodies

MeSH Terms

Antibodies
Biological Products
Child
Electrophoretic Mobility Shift Assay
Humans
Inflammatory Bowel Diseases*
Necrosis*
Antibodies
Biological Products

Figure

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  Fig. 1 Drug serum and anti-drug antibody levels in relation to drug dose intensification and the addition of an immunomodulator. (A) Case 1, (B) Case 2, (C) Case 3, (D) Case 4. IFX: infliximab, ADA: anti-drug antibodies, MTX: methotrexate, ADL: adalimumab.

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