Predictors of response to anti-TNF therapy in RA patients with moderate or high DAS28 scores |
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| Institution: | 1. Rheumatology Unit, L.Sacco University Hospital of Milan, Milan, Italy;2. Day Hospital of Rheumatology, G. Pini Orthopedic Institute, Chair of Rheumatology in Milan, Milan, Italy;3. Rheumatology and Immunology Unit, Spedali Civili di Brescia, Brescia, Italy;4. Chair of Rheumatology, IRCCS Policlinico S. Matteo, Pavia, Italy;5. Internal Medicine, Ospedale di Saronno, A.O. Busto Arsizio, Saronno, Italy;1. Internal Medicine C, Hillel Yaffe Medical Center, Hedera, Israel;2. Rheumatology, Bnai Zion Medical Center, Faculty of Medicine, Technion, Haifa, Israel;1. Biomedicine, University City of São Paulo, São Paulo, Brazil;2. Rheumatology Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil;1. Department of Pediatric Oncology, Hematology and Clinical Immunology, Medical Faculty, Center of Child and Adolescent Health, Heinrich-Heine University, Duesseldorf, Germany;2. BMT laboratory, Department of Pediatric Oncology, Hematology and Clinical Immunology, Medical Faculty, Center of Child and Adolescent Health, Heinrich-Heine University, Duesseldorf, Germany;3. Institute of Diagnostic and Interventional Radiology, Pediatric Radiology, University Hospital Duesseldorf, Duesseldorf, Germany;1. Department of Rheumatology, CHRU de Besançon, boulevard Fleming, 25030 Besançon, France;2. University of Franche-Comté, UPRES EA 4266 Pathogens, Inflammation Laboratory, SFR FED4234, Besançon, France;3. Department of Virology, CHRU de Besançon, place Saint-Jacques, 25030 Besançon, France |
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| Abstract: | ObjectivesTo identify the clinical factors predicting a good clinical response to anti-TNF therapy in rheumatoid arthritis (RA) patients entered in the LORHEN registry after 5 years of treatment with anti-TNF agents and divided into two groups on the basis of their baseline DAS28 scores (moderate > 3.2–5.1 MDA] and high > 5.1 HDA]).MethodsDisease activity at baseline and after 12 months was assessed using the DAS28, and response was evaluated using the EULAR improvement criteria.ResultsThe study involved 1300 patients with established RA: 975 with HDA and 325 with MDA. After a mean 36-month, 29.6% of the patients had a DAS28 score of less or equal to 2.6 (HDA 25.8% vs. MDA 43.0%; P < 0.001) and were considered to be in remission. A higher probability of a good EULAR response in patients with HDA was associated with male gender (F vs. M – OR 0.45, 95% CI 0.26–0.78; P: 0.004), lower age at the start of treatment (OR 0.98, 95% CI 0.96–0.99; P: 0.002), the absence of comorbidities (OR 0.18, 95% CI 0.06–0.52; P: 0.002) or no previous use of corticosteroids (OR 1.92, 95% CI 1.14–3.22; P: 0.015) and the use of adalimumab vs. infliximab (OR 2.21, 95% CI 1.37–3.57; P 0.001); in patients with MDA, the probability of a good EULAR response was associated with male gender (F vs. M – OR 0.39, 95% CI 0.17–0.90; P: 0.027).ConclusionsWith the exception of male gender, the factors predicting a good EULAR response are different in patients with MDA and those with HDA. |
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| Keywords: | High and moderate disease activity DAS28 scores Predictive factors Anti-TNF |
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