Abstract
ObjectiveTo find out whether a high number of auto-antibodies can increase the probability of a “good-EULAR response” and to identify the possible biomarkers of response in seropositive rheumatoid arthritis (RA) patients undergoing the B cell depletion therapy (BCDT).Patients and MethodsOne hundred and thirty-eight patients with long standing RA (LSRA), 75% non or poorly responsive to one or more TNFα blockers, all seropositive for at least one autoantibody (AAB) (RF-IgM, RF-IgA, RF-IgG, anti-MCV, ACPA-IgG, ACPA-IgA, ACPA-IgM) received one full course of BCDT. The major outcomes (moderate or good-EULAR response) were assessed after 6 months of therapy. The IL6 and BAFF levels were also determined.ResultsAt a 6-month follow-up, 33 (23.9%) of the RA patients achieved a good EULAR response. Having up to 5-AABs positivity increased the chances for treatment response. After a logistic regression analysis, however, only 4 baseline factors arose as associated with a good-EULAR response: no steroid therapy (OR = 6.25), a lymphocyte count <1875/uL (OR = 10.74), a RF-IgG level >52.1 IU/ml (OR = 8.37) and BAFF levels <1011 pg/ml (OR = 7.38). When all the AABs, except for RF-IgM and ACPA-IgG, were left in the analysis, the two final predictors were no-steroid therapy and low lymphocyte count.DiscussionThe number of AABs increased the chances of being a “good-EULAR” responder. The only predictors, however, at the baseline of a good response in this seropositive cohort of RA patients were 2 simple variables – no steroids and lymphocyte count – and two laboratory assays – IgG-RF and BAFF.
Highlights
In rheumatoid arthritis (RA), the inflammation in the synovial tissue is an acute-chronic process that is caused by several inflammatory cells and cytokines [1]
After a logistic regression analysis, only 4 baseline factors arose as associated with a good-EULAR response: no steroid therapy (OR = 6.25), a lymphocyte count,1875/uL (OR = 10.74), a rheumatoid factor (RF)-IgG level .52.1 IU/ml (OR = 8.37) and BAFF levels,1011 pg/ml (OR = 7.38)
We addressed the issue of which disease-specific characteristics, as well as biologic parameters, could be predictive factors of response to the B cell depletion therapy (BCDT) in still active RA patients, in a cohort of patients all seropositive for at least one autoantibody (RF-IgG, IgA, or IgM, or anti-citrullinated peptide autoantibodies (ACPA)-IgG, IgA or IgM or antibodies directed against a mutated citrullinated vimentin-anti-MCV)
Summary
In rheumatoid arthritis (RA), the inflammation in the synovial tissue is an acute-chronic process that is caused by several inflammatory cells and cytokines [1]. The BCDT has become a possible second choice due to poor response to TNFa blockers in RA patients [4,5,6]. Data from clinical trials regarding BCDT indicate that patients positive for IgM rheumatoid factor (IgM-RF) and/or for anti-citrullinated peptide autoantibodies (ACPA) are those achieving the best clinical results in terms of ACR or good EULAR response [7,8]. The best candidate for the BCDT has been generally identified as the patient partially or fully refractory to a TNFa blocker, the RF or the ACPA positive. Whether the IgM-RF or the ACPA, or both, are the best available biomarkers associated to treatment response still remains to be demonstrated
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