Abstract
ObjectiveTo explore the baseline predictors of clinical effectiveness after tocilizumab or infliximab treatment in biologic-naïve rheumatoid arthritis patients.MethodsConsecutive biologic-naïve patients with rheumatoid arthritis initiating infliximab (n = 57) or tocilizumab (n = 70) treatment were included in our prospective cohort study. Our cohort started in February 2010, and the patients observed for at least 1 year as of April 2013 were analysed. We assessed baseline variables including patients' characteristics (age, sex, disease duration, prednisolone dose, methotrexate dose, other disease-modifying antirheumatic drug use, Clinical Disease Activity Index [CDAI]) and serum biomarker levels (C-reactive protein, immunoglobulin M-rheumatoid factor, anti-cyclic citrullinated protein/peptide antibodies, interferon-γ, interleukin (IL)-1β, IL-2, IL-6, IL-8, IL-10, IL-17, tumor necrosis factor-α, soluble intercellular adhesion molecule-1, bone alkaline phosphatase, osteonectin, osteopontin) to extract factors associated with clinical remission (CDAI≤2.8) at 1 year using univariate analyses, and the extracted factors were entered into a multivariate logistic regression model. Similar analyses were also performed for Simplified Disease Activity Index (SDAI) remission (≤3.3) and Disease Activity Score with 28 joint counts, erythrocyte sedimentation rate (DAS28-ESR) remission (<2.6).ResultsThere were no significant differences in the baseline characteristics except for methotrexate use between the groups. In the multivariate analyses, the low baseline osteopontin levels (OR 0.9145, 95% CI 0.8399–0.9857) were identified as predictors of CDAI remission in the tocilizumab group, whereas no predictors of CDAI remission were found in the infliximab group. Similar results were obtained when using SDAI and DAS28-ESR remission criteria.ConclusionBaseline low serum osteopontin levels predict clinical remission 1 year after tocilizumab treatment and not infliximab treatment in biologic-naïve patients with rheumatoid arthritis. Our prediction model provided insights into how to optimize the choice of biologics and warrants external validation in other cohorts.
Highlights
Rheumatoid arthritis (RA) is an autoimmune disorder of the synovium that is characterized by the proliferation of synoviocytes and by the infiltration of inflammatory cells into the joint[1]
The low baseline osteopontin levels were identified as predictors of CDAI remission in the tocilizumab group, whereas no predictors of CDAI remission were found in the infliximab group
Our prediction model provided insights into how to optimize the choice of biologics and warrants external validation in other cohorts
Summary
Rheumatoid arthritis (RA) is an autoimmune disorder of the synovium that is characterized by the proliferation of synoviocytes and by the infiltration of inflammatory cells into the joint[1]. Various cytokines have been reported to play an important role in the regulation of inflammatory cells[2]. Biologics targeting tumor necrosis factor (TNF) and interleukin (IL)-6 have made considerable progress in the treatment of RA. Responses to each biologic agent vary by individual. Making an optimal choice of biologics has been expected to capture a therapeutic window of opportunity and to lead to cost-effective medical care. We aimed to identify useful baseline variables and biomarkers measurable in the peripheral blood samples to predict clinical remissions in biologic-naïve RA patients after treatment with tocilizumab (TCZ) or infliximab (IFX)
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