Immunogenicity of Sarilumab Monotherapy in Patients with Rheumatoid Arthritis Who Were Inadequate Responders or Intolerant to Disease-Modifying Antirheumatic Drugs

Abstract

Introduction: This open-label study evaluated the immunogenicity, safety, and efficacy of sarilumab monotherapy in patients with active, moderate-to-severe rheumatoid arthritis (RA) and inadequate response or intolerance to prior conventional synthetic disease-modifying antirheumatic drugs.

Methods: Adults with RA (n = 132) were randomized to receive subcutaneous sarilumab (150 [n = 65] or 200 mg [n = 67]) every 2 weeks (q2w) for 24 weeks. Endpoints included incidence of antidrug antibodies (ADAs) at week 24, safety, and efficacy.

Results: Persistent ADAs occurred in eight patients (12.3%) receiving sarilumab 150 mg q2w, seven of whom (10.8%) had neutralizing antibodies (NAbs), and in four patients (6.1%) receiving sarilumab 200 mg q2w, two of whom (3.0%) had NAbs; all exhibited low antibody titers. Infections and neutropenia were the most common adverse events (AEs). There were three serious AEs, no reports of anaphylaxis, and few hypersensitivity reactions (e.g., rash) with no notable differences in hypersensitivity reactions in ADA-positive patients relative to ADA-negative patients. Changes in absolute neutrophil count, alanine aminotransferase level, and platelet count were consistent with interleukin-6 signaling blockade and in agreement with previous observations. At week 24, overall American College of Rheumatology 20%/50%/70% improvement criteria responses were 73.8%/53.8%/29.2%, respectively, with sarilumab 150 mg q2w and 71.6%/50.7%/29.9% with sarilumab 200 mg q2w. No patients with an ADA-positive response showed loss of efficacy.

Conclusions: ADA titers were low and persistent ADAs and NAbs occurred relatively infrequently in both sarilumab dose groups. ADA did not meaningfully impact the safety or efficacy of either dose of sarilumab over 24 weeks.

Trial registration: ClinicalTrials.gov, identifier NCT02121210.

Funding: Sanofi Genzyme and Regeneron Pharmaceuticals, Inc. Plain language summary available for this article.

Keywords: Arthritis; Biological DMARDs; Rheumatoid arthritis.

Figures

Fig. 1

Detectable (≥ 0.313 mg/l) and non-detectable (ADA antidrug antibody, NAb neutralizing antibody, P-D persistent ADA positivity with detectable sarilumab concentrations, P-ND persistent ADA positivity with non-detectable sarilumab concentrations, q2w every 2 weeks

Fig. 2

Proportions of patients achieving ACR20, ACR50, and ACR70 responses over time. ACR20/50/70 American College of Rheumatology 20%/50%/70% improvement criteria, BL baseline, q2w every 2 weeks