Serum matrix metalloproteinase 3 levels are associated with an effect of iguratimod as add-on therapy to biological DMARDs in patients with rheumatoid arthritis.

Nao Tokai,Yoko Matsumura,Ayaka Yoshikawa,Takuya Kotani,Yuko Kimura,Youhei Fujiki,Shigeki Arawaka,Shigeki Makino,Shuzo Yoshida,Tohru Takeuchi,Sakamuri V Reddy

doi:10.1371/journal.pone.0202601

Abstract

ObjectiveThe aim of this study was to clarify whether serum matrix metalloproteinase 3 (MMP-3) levels are associated with an effect of iguratimod as add-on therapy to biological DMARDs (bDMARDs) in patients with rheumatoid arthritis (RA).MethodsForty three patients with RA were treated with iguratimod as add-on therapy to bDMARDs. They were classified into remission and non-remission groups at 24 weeks of iguratimod therapy. Remission was defined as a state with a disease activity score (DAS) <2.6 in 28 joints (termed DAS remission) and total power Doppler ultrasound (US) score <3 (termed US remission). The serum MMP-3 levels at baseline and at 12 weeks were compared between these two groups.ResultsThere were no significant differences in the serum MMP-3 levels at baseline between the DAS and US remission groups and the non-remission group. The serum MMP-3 levels at 12 weeks in the US remission group were significantly lower than those in the non-remission group. The ratios of the serum MMP-3 levels at baseline to those at 12 weeks in both the DAS and US remission groups were significantly lower than those in the non-remission group. An MMP-3 ratio <0.86 was determined as the cut-off value to predict US remission at 24 weeks.ConclusionOur findings suggest that the ratios of the serum MMP-3 levels at baseline to those at 12 weeks could be used to predict remission in RA patients who are administered iguratimod as an add-on to bDMARDs.

Highlights

The goal of rheumatoid arthritis (RA) therapy is to achieve remission
There were no significant differences in the serum matrix metalloproteinase 3 (MMP-3) levels at baseline between the disease activity score (DAS) and US remission groups and the non-remission group
Our findings suggest that the ratios of the serum Matrix metalloproteinases (MMPs)-3 levels at baseline to those at 12 weeks could be used to predict remission in RA patients who are administered iguratimod as an add-on to biological DMARDs (bDMARDs)

Summary

Introduction

The goal of rheumatoid arthritis (RA) therapy is to achieve remission. Patients with RA are treated with prednisolone, conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), targeted synthetic DMARDs, and biological DMARDs (bDMARDs) as monotherapy or combination therapy. If the patient shows no improvement by 3 months after the start of therapeutic intervention or the patient is unable to achieve remission by 6 months, we usually consider adjunctive therapy [1]. As the indicators of disease activity of RA, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), serum matrix metalloproteinase 3 (MMP-3), disease activity score in 28 joints (DAS28) CRP, DAS28ESR, simplified disease activity index (SDAI), and clinical disease activity index (CDAI) have been proposed. CRP levels do not exactly reflect the disease activity in patients with RA taking bDMARDs [2]. It is necessary to identify useful indicators to predict the disease activity of RA

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Conclusion