The use of monoclonal anti-tumor necrosis factor-alpha (TNFα) antibodies in the treatment of pediatric inflammatory bowel disease (IBD) can result in immunogenicity and the development of anti-drug antibodies (ADAs). ADAs are linked to a lack of clinical response and disease progression. There is a dearth of data on therapy approaches to overcome ADA in pediatric IBD patients.

Medical records from 234 children and adolescents with IBD who were treated with infliximab or adalimumab and underwent therapeutic drug monitoring were evaluated. 

All patients who showed detectable antibodies were subjected to further testing. In total, 58 patients acquired ADA while receiving infliximab or adalimumab treatment. Antibody formation occurred at a rate of 12.9 per 100 person-years of anti-TNF medication. Dose optimization was performed on 28 patients, and 54% had undetectable ADA on follow-up measurement. The average duration of antibody suppression in those who were effectively suppressed with optimization was  16.8 ± 10.9 months. Patients who switched to a second anti-TNF drug did not acquire antibodies to the second agent.

Given the scarcity of IBD treatments and the disease’s chronicity, researchers argue for the salvage of the present anti-TNF by dosage optimization in juvenile patients with antibody levels <10 U/mL.