Interactions affecting antibody formation in pediatric and adult patients treated with tumor necrosis factor therapy for inflammatory bowel disease

Background: Biological therapy is frequently used for the treatment of inflammatory bowel disease (IBD). The efficacy of the most commonly administered infliximab (IFX) and adalimumab (ADA) is impaired in the presence of anti-IFX (AIFX) and anti-ADA (AADA) antibodies. Methods: We analyze data from 153 patients to identify factors associated with AIFX/AADA positivity. We applied hierarchical logistic regression analysis that incorporates relevant clinical variables. Results: The results indicate that gender, age, localization, and IBD type alone do not influence AIFX/AADA positivity. However, the inclusion of treatment-related factors (e.g., type of biological therapy and treatment duration) improved model performance, with the final model achieving an explanatory power of 28.7%. One of the key predictors was the type of biological therapy: IFX treatment substantially increased the prevalence of AIFX positivity compared to ADA. Longer treatment correlated with a higher prevalence of positivity. Additionally, several interactions between variables were significant, particularly the combined effects of age at onset, IBD type, and biological therapy. Conclusion: In summary, the study highlights that the combination of routine clinical variables in IBD support the prediction of AIFX/AADA positivity to a significant, but minor extent.