High Body Mass Index is Associated with Lower Adalimumab Serum Levels and Higher Disease Activity in Noninfectious Uveitis.

Purpose: Adalimumab, a TNF-alpha inhibitor, is the only FDA-approved biologic for non-infectious uveitis (NIU). However, treatment responses vary, potentially due to interindividual pharmacokinetic differences influenced by body mass index (BMI). This study aimed to evaluate the impact of BMI on adalimumab serum trough levels and therapeutic efficacy in patients with NIU.

Design: cross-sectional, clinical study.

Method: Setting: Single-center study. - Study Population: 80 patients with NIU treated with Adalimumab - Observation Procedure: Adalimumab serum trough levels and anti-Adalimumab antibody (AAA) levels were measured. BMI was calculated at treatment initiation, and patients were categorized into normal weight, overweight, obese, and morbidly obese groups. - Main Outcome Measures: The correlation between BMI, adalimumab levels, and clinical response was analyzed using Pearson correlation, chi-square tests, and logistic regression.

Results: Higher BMI was associated with lower adalimumab serum levels and a reduced likelihood of clinical response. A significant negative correlation was found between BMI and adalimumab levels (r = -0.408, P = .007). Logistic regression identified BMI as a significant predictor of treatment response (P = .017). A BMI threshold of 26.4 was identified, above which the probability of a positive response significantly decreased. Additionally, 51.2% of patients were non-responders, all of whom demonstrated detectable AAA.

Conclusions: Higher BMI is associated with lower adalimumab trough levels and reduced treatment efficacy in NIU patients. A BMI threshold of 26.4 may serve as a clinical marker for tailoring adalimumab therapy, highlighting the need for personalized dosing strategies in patients with elevated BMI.