Preventing and Detecting Antibodies to Anti–Tumor Necrosis Factor Agents: Gaps in Practice or in Evidence?

Although anti–tumor necrosis factor (TNF) agents are considered highly effective therapies for psoriasis, treatment failure is common. As highlighted in the study by Menting et al,¹ primary failure is more frequent in the “real-world” setting compared with randomized clinical trials with adalimumab and is associated with formation of antidrug antibodies (ADAs) and low serum drug levels. This article further highlights the high frequency of ADA formation (50%) in patients not receiving concomitant methotrexate. These issues raise 2 questions: (1) should adalimumab be prescribed with methotrexate at the outset and (2) should ADA and trough drug levels be drawn when patients fail to respond to adalimumab to aid in the decision to escalate dose or switch therapy?