Immunological Changes in Peripheral Blood of Ankylosing Spondylitis Patients during Anti-TNF-α Therapy and Their Correlations with Treatment Outcomes.

Rongjuan Chen,Bin Wang,Hongyan Qian,Yuan Liu,Xiaoqing Yuan,Guixiu Shi,Shiju Chen,Cinzia Ciccacci

doi:10.1155/2021/1017938

Abstract

Tumor necrosis factor-α (TNF-α) inhibitors are the main types of biological conventional synthetic disease-modifying antirheumatic drugs and have efficacy in treating ankylosing spondylitis (AS) which is not sensitive for nonsteroidal anti-inflammatory drug. However, the impact of TNF-α inhibitors on immune cells in patients with AS is still clearly undefined, and the impact of immune cells on treatment response is also largely elusive. This study is aimed at evaluating the longitudinal changes of circulating immune cells after anti-TNF-α therapy and their associations with treatment response in AS patients. Thirty-five AS patients receiving the treatment of anti-TNF-α therapy were included into this prospective observational study. The frequencies of immune cells including Th1, Th2, Th17, regulatory T cell (Treg), T follicular helper cell (Tfh), and regulatory B cell (Breg) in the peripheral blood were measured by flow cytometry at baseline and 4 time points after therapy. The difference in the circulating immune cells between responders and nonresponders was compared. This study suggested that anti-TNF-α therapy could significantly reduce circulating proinflammatory immune cells such as Th17 and Tfh, but significantly increased the percentages of circulating Treg and Breg. Moreover, circulating Breg may be a promising predictor of response to anti-TNF-α therapy in AS patients.

Highlights

Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease characterized by inflammatory back pain and progressive ankylosing in spine [1]
Tumor necrosis factor-α (TNF-α) inhibitors are the main types of biological disease-modifying antirheumatic drugs (DMARDs) and have a well-established efficacy in treating AS, which has largely revolutionized the treatment of AS in the past two decades [8]
Inclusion criteria were as follows: (1) patients met the 1984 modified New York classification criteria for AS; (2) without treatment history of biological DMARDs such as anti-TNF agents, anti-IL-17 agents, and anti-IL-6 agents; (3) with a Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score of no less than 1; (4) data of clinical characteristics and laboratory testing analyzed in this study were available; (5) receiving a standard treatment of anti-TNF-α inhibitors; and (6) without obvious infections such as tuberculosis

Summary

Introduction

Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease characterized by inflammatory back pain and progressive ankylosing in spine [1]. NSAID is not effective for some AS patients especially for those with later stages, and a large part of AS patients are still poorly controlled in clinical practice [5]. Those AS patients need additional treatment with conventional synthetic disease-modifying antirheumatic drugs (DMARDs) or biological DMARDs [5,6,7]. Minimize infection risk, and reduce costs, it is critical for clinicians to identify responders to specific biological DMARDs and make adequate therapeutic decisions

Objectives

Methods

Results

Conclusion