Background/Purpose: Tumor necrosis factor (TNF) inhibitors (TNFi) are effective treatments for rheumatoid arthritis (RA). Some reports suggested that TNFi affect B cell homeostasis.  We studied the effect of TNFi on peripheral B cells and elucidated B cell related biomarkers to predict TNFi response.

Methods: Peripheral B cells were analyzed for expression of CD19, CD27, CD38, IgD in 31 healthy donors and 96 RA patients, including 21 patients who were followed 3 months after TNFi introduction. We compared B cell subsets between patients with RA and controls; TNFi and non TNFi users as well as before and after TNFi introduction in RA patients. We also aimed to identify phenotypes associated with EULAR response.

Results: B cell subsets in blood were influenced by age and glucocorticoids doses. After adjustment on age, gender and glucocorticoid doses, patients with RA were found to have similar B cell subset frequencies as controls. No significant effect of TNFi on B cell repartition was found when comparing TNFi and non TNFi users at baseline or patients before and after TNFi introduction. TNFi responders at 3 months had significantly higher percentage of CD27⁺ memory B cells at baseline and those with CD27⁺ above 26% at inclusion were 4.9 (1.3-18.6) more likely to respond TNFi treatment. CD27⁺ cells produced 3 times more TNF alpha than naïve B cells which was correlated with IFN gamma-producing CD4⁺in patients free of TNFi.

Conclusion: High levels of memory B cells at baseline were associated with response to TNFi which may be related to the  activation of the Th1 pathway in a TNFa depending manner.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/high-levels-of-memory-b-cells-are-associated-with-response-to-a-first-anti-tnf-drug-in-patients-with-rheumatoid-arthritis/