Are There Any Associations between ANA Development and Poor Treatment Response to Bdmards in RA Patients?

Yuki Ishikawa¹, Motomu Hashimoto², Hiromu Ito³, Masao Tanaka², Naoichiro Yukawa⁴, Takao Fujii⁵, Wataru Yamamoto⁶, Tsuneyo Mimori⁷ and Chikashi Terao^8,9,10, ¹One Joslin Place, Joslin Diabetes Center, Harvard Medical School, Boston, MA, ²Department of Advanced Medicine for Rheumatic Diseases, Graduate School of Medicine, Kyoto University, Kyoto, Japan, ³Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan, ⁴Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Wakayama University, Wakayama, Japan, ⁵Dept of Rheum/Clinical Immun, Wakayama Medical University, Wakayama, Japan, ⁶Department of Health Information Management, Kurashiki Sweet Hospital, Okayama, Japan, ⁷Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan, ⁸Center for Investigative Medical Sciences, RIKEN, Yokohama, Japan, ⁹Clinical Research Center, Shizuoka General Hospital, Shizuoka, Japan, ¹⁰Department of Applied Genetics, The School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: ANA, anti-TNF therapy, autoantibodies and rheumatoid arthritis (RA), Biologic agents

Session Information

Date: Sunday, October 21, 2018

Title: Rheumatoid Arthritis – Treatments Poster I: Strategy and Epidemiology

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: It has been well known that anti-TNF-α treatment for RA patients is associated with ANA development. We previously reported that ANA development along with ANA levels at base line were associated with poor outcomes of infliximab (IFX)(1). However, no replication studies have been reported. In addition, whether the findings are true to general biologic DMARDs (bDMARDs) is uncertain. Here, we evaluate an association between poor treatment response and ANA development during bDMARDs treatment in RA patients and analyze correlates of ANA development.

Methods: Japanese RA patients treated with (n=657) or without (n=211) bDMARDs (IFX, etanercept ETN, adalimumab ADA, golimumab GLM, certolizumab pegol CZP, tocilizumab TCZ, abatacept ABT) as a first line bDMARD were enrolled from a single center cohort. The study participants were not registered in the previous study (1). ANA was measured by indirect immunofluorescence assays at multiple time points of treatment. We conducted multiple logistic linear regression analysis to assess effects of ANA development on treatment outcomes. We further analyzed correlates of ANA development by using patients with RA who were treated by MTX but not by bDMARDs as controls.

Results: ANA development (≥ 2 times baseline levels) at 3 months and at 6-12 months after bDMARDs initiation were significantly associated with insufficient response within a year (odds ratio (OR)=3.51, p=0.020) and between 12 and 24 months (OR=3.16, p=0.038), respectively. The associations remained significant after conditioning on each bDMARD use (OR=3.16-3.56, p<0.05), indicating the observed association was not limited to IFX use.

The use of IFX was a risk for ANA development (OR=6.36, p<0.001), and the use of other TNF-α inhibitors (TNFi) also showed the same tends as IFX use (OR=1.68, p=0.214). On the other hand, the use of non-TNFi bDMARDs was not associated with ANA development (OR=0.792, p=0.675).

Conclusion: ANA development could be a marker of poor treatment response in RA patients undergoing bDMARDs treatment. Undefined common factors among RA patients treated with bDMARDs might influence ANA development and subsequent poor treatment outcome.

Reference:

1. Yukawa N, Fujii T, Kondo-Ishikawa S, Yoshifuji H, Kawabata D, Nojima T, et al. Correlation of antinuclear antibody and anti-double-stranded DNA antibody with clinical response to infliximab in patients with rheumatoid arthritis: a retrospective clinical study. Arthritis Res Ther. 2011;13(6):R213.

Disclosure: Y. Ishikawa, None; M. Hashimoto, None; H. Ito, None; M. Tanaka, None; N. Yukawa, None; T. Fujii, None; W. Yamamoto, None; T. Mimori, None; C. Terao, None.

To cite this abstract in AMA style:

Ishikawa Y, Hashimoto M, Ito H, Tanaka M, Yukawa N, Fujii T, Yamamoto W, Mimori T, Terao C. Are There Any Associations between ANA Development and Poor Treatment Response to Bdmards in RA Patients? [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/are-there-any-associations-between-ana-development-and-poor-treatment-response-to-bdmards-in-ra-patients/. Accessed .

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