Session Information
Date: Sunday, November 8, 2015
Title: Rheumatoid Arthritis - Small Molecules, Biologics and Gene Therapy Poster I
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: Therapeutic target in rheumatoid arthritis (RA) aims at achieving remission or low disease activity. Among the known poor prognostic factors are anti–citrullinated protein antibody (ACPA) and rheumatoid factor (RF). Clinical significance and therapeutic implications of the positivity of antinuclear antibodies (ANA) in serum of RA patients before starting the biological treatment is still under debate.
Purpose: The implications of ANA positivity, as a prognostic factor, in the therapeutic response to biologic therapy in RA, as measured by DAS28 score.
Methods: observational study; all data were gathered from the electronic database of Romanian Registry of Rheumatic Diseases (RRBR) which comprises all RA patients following biological treatment in the country. There were included only RA patients who were evaluated for the presence of ANA, before initiating any biologic therapy.
Results: 740 RA patients were included in the study, mean age 56.50 years (± 12.59), 84.5% women, mean disease duration 12.54 years (± 7.67). At baseline (prior to any biologic start), 26.9% patients were positive for ANA, 89.8% for RF, 37% for ACPA, 35.1% were double seropositive ( for RF and ACPA) while 13.1% were triple seropositive (RF, ACPA, and ANA) and the mean DAS28 was 5.09 ± 2.35. 72.4% patients were treated with TNF-alpha blockers, while 27.6% with anti-CD20 drugs. During evolution, 22% of subjects required switch of therapy. Biologics persistency (the duration of therapy under one drug) was 31.70 (± 29.95) months and the latest DAS 28 score was 2.90 ± 1.41. There were statistically significant differences between DAS28 values at all assessments, depending on the presence of ANA. At biological start, DAS28 score in ANA positive group was 5.70 ± 2.06, while in ANA negative group was 4.86 ± 2.41 (p <0.001). Concerning efficacy, assessed by the latest DAS28, ANA positive group had a score of 3.32 ± 1.61, compared to 2.74 ± 1.30 in ANA negative patients (p <0.001). The drug persistence in ANA positive patients was 22.65 ± 25.68 months, versus 34.86 ± 30.71 months in ANA negative group (p <0.001). For patients who required switch of therapy, DAS28 score at switch time was 5.42 ± 1.52 in ANA positive group, versus 4.79 ± 1.80 in ANA negative group (p = 0.05). There is a poor positive association between ANA positivity and DAS28 at all assessments (r = 0.2, p <0.01) and ACPA positivity (r = 0.2, p <0.01) and a negative correlation between ANA positivity and drug persistence (r = – 0.2, p <0.01). Linear regression showed that the best predictor of the current value of DAS28 is ANA positivity, independent of the presence of RF, ACPA, double or triple seropositivity (t=2, p<0.05).
Conclusion: ANA positivity in patients with RA, before starting any biological therapy, may be a poor prognostic factor for the therapeutic efficacy, as well as for the drug persistence. More studies are needed to confirm these observations.
To cite this abstract in AMA style:
Mogosan C, Enache L, Stanciu D, Opris D, Rednic S, Parvu M, Popoviciu H, Ionescu R, Codreanu C. Value of Antinuclear Antibodies As a Predictor of Therapeutic Efficacy of Biologics in Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/value-of-antinuclear-antibodies-as-a-predictor-of-therapeutic-efficacy-of-biologics-in-rheumatoid-arthritis/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/value-of-antinuclear-antibodies-as-a-predictor-of-therapeutic-efficacy-of-biologics-in-rheumatoid-arthritis/