Incidence of Anti-Drug Antibody Development in Older Adults with Inflammatory Bowel Disease Treated with Tumor Necrosis Factor Alpha Inhibitors: A Large Multicenter Cohort Study
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Updated: Jan 17, 2026

Mechanistic Insight into the Development of TNBS-Mediated Intestinal Fibrosis and Evaluating the Inhibitory Effects of Rapamycin
Published on: September 12, 2019
Spencer Frost1, Chetan Ambastha2, Devin Patel3
1Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, United States.
Background:
It has been theorized that age related immunosenescence reduces the risk of developing anti-drug antibodies (ADAs). This has significant implications regarding choice of therapy and need for routine drug monitoring in this group. We investigated the incidence of ADAs in older adults compared to younger adults with inflammatory bowel disease (IBD).
Methods:
We conducted a multicenter retrospective cohort study including all older adults (ages ≥60 years) with IBD treated with a tumor necrosis factor inhibitors (TNFi); adults ages 18-59 years old were included in a 4:1 ratio. Kaplan-Meier and Cox regression methods compared longitudinal risk of ADA development between groups. Multivariable models evaluated the association of potential risk factors with ADA development.
Results:
182 (19.7%) older adults and 738 (80.2%) younger adults were included in the study. The risk of ADAs was higher in older adults compared to younger adults (adjusted hazard ratio [aHR] 2.20; 95% confidence interval [CI] 1.44-3.36). Proactive therapeutic drug monitoring (TDM) was inversely associated with ADA development (aHR 0.36; 95% CI 0.25-0.52).
Conclusion:
Older adults are more likely to develop ADAs against TNFi compared to younger adults. Proactive TDM may be considered in this population for early identification of ADAs and subtherapeutic trough levels, enabling timely dose escalation or treatment modification.
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