Influence of Immunogenicity of Adalimumab on Prognosis of Patients with Non-Infectious-Uveitis: A Systematic Review

Non-infectious uveitis (NIU) is a major cause of visual loss among young adults, and the available therapies are limited. Adalimumab (ADA), an antibody targeting tumour necrosis factor α (TNF-α), is an effective treatment. This review aims to examine immunogenicity of ADA, and its association with serum ADA trough levels (SATL) and the risk of treatment failure. A systematic review of the literature was conducted, following PRISMA guidelines. Studies published between 2019 and 2023 were included. After applying the inclusion criteria, 10 articles were selected. The risk of bias was evaluated using the most appropriate method for each type of study. In total 10 studies were finally included. Most of the investigation reported the formation of anti-ADA antibodies (AAA), which was associated with low SATL and poor treatment response. Some studies also distinguished between transient and permanent AAA, with transient AAA linked to a higher risk of treatment failure. Risk factors for AAA development were explored, with many studies highlighting the benefits of combined therapy with ADA and other immunosuppressants compared with ADA monotherapy. The association between low SATL, AAA, and poor response to ADA treatment is well established. However, further high-quality investigations are needed to strengthen the evidence in this area. Therapeutic monitoring strategies appear to be valuable tools for providing personalized management for patients with NIU.