Table 3.

Factors related to immunogenicity of anti-TNF therapy in IBD

Factor	ADA	Ref.
Patient-related
Genetic predisposition: HLA-DRB1*03	↑	48
Gender: male†	↑	7 31 45 49
Ethnicity: Jewish Ashkenazi	↓	50
BMI: high or low†	↑	45 47 49
CRP: elevated†	↑	7 11 31 32 49
Albumin: low†	↑	7 47 49
Disease-related
IBD type: (acute severe) UC†	↑	7 17 20 31
TNF load: higher†	↑	51
Endoscopic severity: higher Mayo score in UC†	↑	7 31
Treatment-related
Concomitant medication: IMM‡	↓	7 8 10 15 20 23 49 52–54
Dose and frequency: high§	↓	55
Type of therapy: episodic	↑	15 20 55
Previous medication: prior anti-TNF therapy	↑	28 36 51

†Probably related, via undetectable or low drug concentrations due to faster non-immune clearance as a result of higher disease inflammatory burden.

‡Thiopurines, methotrexate.

§In patients not receiving IMM, there was approximately twofold difference in ADA prevalence between 5 and 10 mg/kg doses, suggesting that lower doses were more immunogenic in the absence of IMM.

ADA, antidrug antibodies; BMI, body mass index; CRP, C reactive protein; HLA, human leucocyte antigen; IBD, inflammatory bowel disease; IMM, immunomodulators; TNF, tumour necrosis factor; UC, ulcerative colitis.