Utility of detecting anti-drug antibodies using a bridging ELISA compared to radioimmunoassay in adalimumab treated rheumatoid arthritis patients with random drug levels

Objectives: To determine the concordance between RIA and bridging ELISA at detecting anti-drug antibodies (ADAbs) in the context of random adalimumab levels and investigate the additional clinical utility of detecting ADAbs in RA patients who test ADAb positive by RIA and negative by ELISA. Methods: ADAb levels were determined using RIA and bridging ELISA in 63 adalimumab treated RA patients (159 samples). Immunogenicity concordance was determined using receiver-operating characteristic (ROC) curves. To determine the additional clinical value provided by a positive RIA in the presence of negative ELISA, association between treatment response (ΔDAS28), adalimumab drug levels and ADAbs was evaluated longitudinally using generalised estimating equation. Results: Of the 60 RIA+ samples (n=31 patients), 19 (n=10 patients) were also ELISA+, corresponding to 31.7% of samples. Area under the curve (AUC) for detecting ADAbs using ELISA (compared with RIA) using ROC curves was 0.65 (95% CI: 0.59-0.71); this increased to 0.91 (95% CI: 0.81-0.99) if ADAbs were ≥100 AU/ml using RIA. In RIA+/ELISA- patients, adalimumab levels were associated with ΔDAS28 over 12 months [regression coefficient: 0.098 (0.043-0.15), p<0.0001] and whilst ADAbs were significantly associated with drug level, they were not directly associated with ΔDAS28 over 12 months [β coefficient: 0.00083 (-0.0038 to 0.0054), p=0.72]. Conclusion: ADAbs were detected using ELISA more frequently when present in high titres as measured by RIA. In RIA+/ELISA- patients, only drug levels were significantly associated with treatment response. Although ADAbs were not independently associated with treatment response, they may be helpful in determining the aetiology of low drug levels. Concordance between ELISA and RIA in detecting ADAbs.