Prevalence and clinical relevance of anti-drug antibodies in psoriatic arthritis: a systematic review

James Kimpton; Akpabio Akpabio; Andrew Watts; Sarah Tansley; Theresa Smith; Neil McHugh; William Tillett

doi:10.1136/rmdopen-2026-007140

Prevalence and clinical relevance of anti-drug antibodies in psoriatic arthritis: a systematic review

Royal National Hospital for Rheumatic Diseases

Research output: Contribution to journal › Article › peer-review

Abstract

OBJECTIVES: To determine the prevalence of anti-drug antibodies (ADAs) in patients with psoriatic arthritis (PsA) treated with biological disease-modifying antirheumatic drugs (bDMARDs) and to evaluate associations with serum drug levels, clinical efficacy and safety.

METHODS: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-guided systematic review was conducted. MEDLINE, Embase and Cochrane CENTRAL were searched from inception to September 2025. Randomised controlled trials and observational studies reporting ADA measurement in adults with PsA receiving bDMARDs were included. The risk of bias was assessed using the Cochrane Risk of Bias Tool 2 and the Risk of Bias in Non-randomised Studies of Interventions.

RESULTS: 28 studies (19 randomised controlled trials and 9 observational studies) were included. ADA prevalence varied widely between bDMARDs and across studies of the same drug and was not directly comparable due to immunoassay heterogeneity. The highest ADA prevalence was observed with adalimumab, infliximab and golimumab followed by ustekinumab, ixekizumab, certolizumab pegol and guselkumab, while secukinumab and etanercept demonstrated very low or absent immunogenicity. Across tumour necrosis factor (TNF) inhibitor studies, ADAs were consistently associated with lower serum drug levels and reduced clinical response, while concomitant methotrexate was associated with lower ADA prevalence. In contrast, serum drug level and clinical outcome data for interleukin (IL)-17, IL-12/23 and IL-23 inhibitors were limited or lacking. Immunogenicity-related adverse events were uncommon, and evidence was insufficient to establish an association with ADAs across bDMARDs.

CONCLUSION: ADA prevalence in PsA varies widely between bDMARDs and across studies of the same bDMARD. ADAs appear most clinically relevant for TNF inhibitors, whereas evidence for other biological classes remains limited. Immunoassay heterogeneity limits comparability, highlighting the need for standardised prospective studies.

PROSPERO REGISTRATION NUMBER: CRD420251121662.

Original language	English
Article number	e007140
Journal	RMD Open
Volume	12
Issue number	3
Early online date	19 Aug 2026
DOIs	https://doi.org/10.1136/rmdopen-2026-007140
Publication status	Published - 19 Aug 2026

Data Availability Statement

All data relevant to the study are included in the
article or uploaded as supplementary information. Any additional data not available
will be shared on reasonable request to the corresponding author.

Funding

JK’s PhD studentship is co-funded by the University of Bath through the University Research Studentship Award (URSA) and the Bath Institute for Rheumatic Disease (BIRD; RAG-WT-45-250801). The funders had no role in the study design; the collection, analysis or interpretation of the data; the writing of the manuscript or the decision to submit the manuscript for publication

Keywords

Antibodies
Arthritis, Psoriatic
Biological Therapy

ASJC Scopus subject areas

Rheumatology
Immunology and Allergy
Immunology

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10.1136/rmdopen-2026-007140Licence: CC BY-NC

Cite this

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title = "Prevalence and clinical relevance of anti-drug antibodies in psoriatic arthritis: a systematic review",

abstract = "OBJECTIVES: To determine the prevalence of anti-drug antibodies (ADAs) in patients with psoriatic arthritis (PsA) treated with biological disease-modifying antirheumatic drugs (bDMARDs) and to evaluate associations with serum drug levels, clinical efficacy and safety.METHODS: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-guided systematic review was conducted. MEDLINE, Embase and Cochrane CENTRAL were searched from inception to September 2025. Randomised controlled trials and observational studies reporting ADA measurement in adults with PsA receiving bDMARDs were included. The risk of bias was assessed using the Cochrane Risk of Bias Tool 2 and the Risk of Bias in Non-randomised Studies of Interventions.RESULTS: 28 studies (19 randomised controlled trials and 9 observational studies) were included. ADA prevalence varied widely between bDMARDs and across studies of the same drug and was not directly comparable due to immunoassay heterogeneity. The highest ADA prevalence was observed with adalimumab, infliximab and golimumab followed by ustekinumab, ixekizumab, certolizumab pegol and guselkumab, while secukinumab and etanercept demonstrated very low or absent immunogenicity. Across tumour necrosis factor (TNF) inhibitor studies, ADAs were consistently associated with lower serum drug levels and reduced clinical response, while concomitant methotrexate was associated with lower ADA prevalence. In contrast, serum drug level and clinical outcome data for interleukin (IL)-17, IL-12/23 and IL-23 inhibitors were limited or lacking. Immunogenicity-related adverse events were uncommon, and evidence was insufficient to establish an association with ADAs across bDMARDs.CONCLUSION: ADA prevalence in PsA varies widely between bDMARDs and across studies of the same bDMARD. ADAs appear most clinically relevant for TNF inhibitors, whereas evidence for other biological classes remains limited. Immunoassay heterogeneity limits comparability, highlighting the need for standardised prospective studies.PROSPERO REGISTRATION NUMBER: CRD420251121662.",

keywords = "Antibodies, Arthritis, Psoriatic, Biological Therapy",

author = "James Kimpton and Akpabio Akpabio and Andrew Watts and Sarah Tansley and Theresa Smith and Neil McHugh and William Tillett",

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doi = "10.1136/rmdopen-2026-007140",

language = "English",

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TY - JOUR

T1 - Prevalence and clinical relevance of anti-drug antibodies in psoriatic arthritis

T2 - a systematic review

AU - Kimpton, James

AU - Akpabio, Akpabio

AU - Watts, Andrew

AU - Tansley, Sarah

AU - Smith, Theresa

AU - McHugh, Neil

AU - Tillett, William

PY - 2026/8/19

Y1 - 2026/8/19

N2 - OBJECTIVES: To determine the prevalence of anti-drug antibodies (ADAs) in patients with psoriatic arthritis (PsA) treated with biological disease-modifying antirheumatic drugs (bDMARDs) and to evaluate associations with serum drug levels, clinical efficacy and safety.METHODS: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-guided systematic review was conducted. MEDLINE, Embase and Cochrane CENTRAL were searched from inception to September 2025. Randomised controlled trials and observational studies reporting ADA measurement in adults with PsA receiving bDMARDs were included. The risk of bias was assessed using the Cochrane Risk of Bias Tool 2 and the Risk of Bias in Non-randomised Studies of Interventions.RESULTS: 28 studies (19 randomised controlled trials and 9 observational studies) were included. ADA prevalence varied widely between bDMARDs and across studies of the same drug and was not directly comparable due to immunoassay heterogeneity. The highest ADA prevalence was observed with adalimumab, infliximab and golimumab followed by ustekinumab, ixekizumab, certolizumab pegol and guselkumab, while secukinumab and etanercept demonstrated very low or absent immunogenicity. Across tumour necrosis factor (TNF) inhibitor studies, ADAs were consistently associated with lower serum drug levels and reduced clinical response, while concomitant methotrexate was associated with lower ADA prevalence. In contrast, serum drug level and clinical outcome data for interleukin (IL)-17, IL-12/23 and IL-23 inhibitors were limited or lacking. Immunogenicity-related adverse events were uncommon, and evidence was insufficient to establish an association with ADAs across bDMARDs.CONCLUSION: ADA prevalence in PsA varies widely between bDMARDs and across studies of the same bDMARD. ADAs appear most clinically relevant for TNF inhibitors, whereas evidence for other biological classes remains limited. Immunoassay heterogeneity limits comparability, highlighting the need for standardised prospective studies.PROSPERO REGISTRATION NUMBER: CRD420251121662.

AB - OBJECTIVES: To determine the prevalence of anti-drug antibodies (ADAs) in patients with psoriatic arthritis (PsA) treated with biological disease-modifying antirheumatic drugs (bDMARDs) and to evaluate associations with serum drug levels, clinical efficacy and safety.METHODS: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-guided systematic review was conducted. MEDLINE, Embase and Cochrane CENTRAL were searched from inception to September 2025. Randomised controlled trials and observational studies reporting ADA measurement in adults with PsA receiving bDMARDs were included. The risk of bias was assessed using the Cochrane Risk of Bias Tool 2 and the Risk of Bias in Non-randomised Studies of Interventions.RESULTS: 28 studies (19 randomised controlled trials and 9 observational studies) were included. ADA prevalence varied widely between bDMARDs and across studies of the same drug and was not directly comparable due to immunoassay heterogeneity. The highest ADA prevalence was observed with adalimumab, infliximab and golimumab followed by ustekinumab, ixekizumab, certolizumab pegol and guselkumab, while secukinumab and etanercept demonstrated very low or absent immunogenicity. Across tumour necrosis factor (TNF) inhibitor studies, ADAs were consistently associated with lower serum drug levels and reduced clinical response, while concomitant methotrexate was associated with lower ADA prevalence. In contrast, serum drug level and clinical outcome data for interleukin (IL)-17, IL-12/23 and IL-23 inhibitors were limited or lacking. Immunogenicity-related adverse events were uncommon, and evidence was insufficient to establish an association with ADAs across bDMARDs.CONCLUSION: ADA prevalence in PsA varies widely between bDMARDs and across studies of the same bDMARD. ADAs appear most clinically relevant for TNF inhibitors, whereas evidence for other biological classes remains limited. Immunoassay heterogeneity limits comparability, highlighting the need for standardised prospective studies.PROSPERO REGISTRATION NUMBER: CRD420251121662.

KW - Antibodies

KW - Arthritis, Psoriatic

KW - Biological Therapy

UR - https://www.scopus.com/pages/publications/105047884710

U2 - 10.1136/rmdopen-2026-007140

DO - 10.1136/rmdopen-2026-007140

M3 - Article

C2 - 42618212

SN - 2056-5933

VL - 12

JO - RMD Open

JF - RMD Open

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M1 - e007140

ER -

Prevalence and clinical relevance of anti-drug antibodies in psoriatic arthritis: a systematic review

Abstract

Data Availability Statement

Funding

Keywords

ASJC Scopus subject areas

Access to Document

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