It is not clear whether combination therapy with immunomodulators affects the immunogenicity of tumor necrosis factor (TNF) antagonists in patients with inflammatory bowel disease.
Dr Min-hu Chen and colleagues from China performed a meta-analysis to quantify the effects of combined immunomodulator therapy on the presence of antibodies against TNF antagonists, and trough levels of anti-TNF agents.
The team systematically searched publication databases for studies that reported prevalence of ADAs in patients who received anti-TNF agents.
Raw data from studies that met the inclusion criteria were pooled to determine effect estimates.
The researchers performed subgroup and metaregression analyses to determine the level of heterogeneity among study outcomes.
The team analyzed findings from 35 studies that met inclusion criteria.
|The protective effect of immunomodulators did not differ with type of drug patients were given|
|Clinical Gastroenterology & Hepatology|
The researchers noted that the pooled risk ratio for formation of ADAs in patients receiving combined therapy with immunomodulators, versus that of patients receiving anti-TNF monotherapy, was 0.49.
However, the pooled analysis did not demonstrate a significant difference in trough levels of anti-TNF agents between patients with versus without concurrent use of immunomodulators.
Subgroup analyses of patients treated with different TNF antagonists revealed no difference in the formation of ADAs.
The team noted that the protective effect of immunomodulators did not differ with type of drug patients were given, or assay for ADA.
The research team observed heterogeneity only among studies of patients with ulcerative colitis.
Dr Chen's team concludes, "In a meta-analysis of published studies, we associated combined treatment with immunomodulators with reduced risk of formation of antibodies against TNF antagonists in patients with inflammatory bowel disease."