Date: Sunday, October 21, 2018
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.
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.
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 10). https://acrabstracts.org/abstract/are-there-any-associations-between-ana-development-and-poor-treatment-response-to-bdmards-in-ra-patients/. Accessed April 8, 2020.
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