Anti-TNF immunogenicity in a Middle Eastern inflammatory bowel disease cohort: prevalence, predictors and context-specific drug level thresholds.

The difference between pre-event and non-immunogenic drug levels was highly significant (p<0.001), and this held for each drug individually (both p<0.001) ( figure 3 ).

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On shared frailty Cox regression, previous surgery was more strongly associated with immunogenicity (HR 2.80, 95% CI 1.41 to 5.56, p=0.003), and concomitant immunomodulator use showed a trend towards protection (HR 0.52, 95% CI 0.26 to 1.02, p=0.057).

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Among 61 patients who received both infliximab and adalimumab sequentially, the rate of immunogenicity to the second anti-TNF was numerically higher in patients who were immunogenic to the first agent (13/32, 40.6%) compared with those who were not (8/29, 27.6%), although this association did not reach statistical significance (OR 1.78, 95% CI 0.54 to 6.15; p=0.42).

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