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Abstract Number: 2926

Calprotectin Serum Levels Reflect Residual Inflammatory Activity in Patients with Rheumatoid Arthritis and Psoriatic Arthritis on Clinical Remission or Low Disease Activity Undergoing TNF-Antagonists Therapy

Jose Inciarte-Mundo1, M. Victoria Hernández1, Sonia Cabrera-Villalba1, Julio Ramirez1, Andrea Cuervo1, Virginia Ruiz-Esquide1, Azucena González Navarro2, Jordi Yagüe3, Juan D. Cañete1 and Raimon Sanmarti1, 1Arthritis Unit. Rheumatology Department, Hospital Clínic of Barcelona, Barcelona, Spain, 2Immunology Department, Hospital Clínic of Barcelona, Barcelona, Spain, 3Immunology Department, Hospital Clinic Barcelona, Barcelona, Spain

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: Biologic agents, Disease Activity, remission and rheumatoid arthritis (RA)

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Session Information

Title: Rheumatoid Arthritis - Small Molecules, Biologics and Gene Therapy VI: Biomarkers and Predictors of Rheumatoid Arthritis Disease Response and Outcomes

Session Type: Abstract Submissions (ACR)

Background/Purpose: Calprotectin is a major S100 leucocyte protein, is associated to disease activity in rheumatoid arthritis (RA) and Psoriatic Arthritis (PsA) patients. Calprotectin is a potentially biomarker more sensitive of disease activity than conventional acute-phase proteins. 

Objective: To analyze the relationship between calprotectin serum levels and inflammatory disease activity in patients with RA and PsA patients in clinical remission or low disease activity treated with TNF-antagonists. To correlate calprotectin levels with serum trough levels of TNF-antagonists.

Methods: Prospective cohort study of patients diagnosed with RA (ACR 1987 criteria) or PsA (CASPAR criteria) treated with adalimumab (ADA), etanercept (ETN) or infliximab (IFX) for ≥ 3 months in clinical remission or with low disease activity measured by DAS28-ESR in ≥ 2 consecutive visits. Clinical and laboratory data were analyzed. Calprotectin serum levels (using kits from Calpro AS, Norway) and TNF-antagonist serum trough levels, anti-drug antibodies (Abs) (using kits from Promonitor®, Progenika SA) were determined at 0, 4, 8 and 12 months of follow-up. We present the results at study entry (visit 0). 

Results: 103 patients (47 RA, 56 PsA) were included. 61% female, mean age 58±12 years, mean DAS28-ESR 2.1±0.58, 76% were in clinical remission and 24% in low disease activity, 48% on monotherapy, 44% receiving reduced dosage of biologic (ADA 18 patients, ETN 22 patients and IFX 5 patients).  Calprotectin levels were significantly lower in PsA than in RA patients (1.4±1 vs. 2.2±1, p=0.006). Patient on clinical remission (DAS28<2.6) showed lower calprotectin levels to those observed in those with low disease activity (1.2±1 vs. 3.4±1, p<0.0001), even when distributed by the most stringent remission criteria (patients with SDAI <3.3 1.4±1 vs. SDAI>3.3 1.9±2, p=0.005). Calprotectin strongly correlates with DAS28-ESR and SDAI in both RA (rs=0.744, p<0.0001 and rs=0.328, p=0.025 respectively) and PsA (rs=0.777, p<0.0001 and rs=0.419, p=0.001 respectively), whereas no correlation was found between CRP serum levels or ESR with DAS28-ESR and SDAI in both populations. A trend for higher calprotectin levels in patients with low serum trough levels of ADA was showed (n=17, rs=-0.413, p=0.09), that was statistically significant in those patients with RA treated with adalimumab at standard dose (rs=-0.767, p=0.026). No correlations between calprotectin and serum trough levels ETN or IFX were observed.   

Conclusion: Calprotectin was found to have high accuracy to discriminate RA or PsA patients in remission from those in low disease activity undergoing TNF-antagonists therapy, reflecting ongoing inflammatory activity. A strong correlation between disease activity measured by DAS28 and SDAI and calprotectin, but not with CRP or ESR, was found. No clear correlation between calprotectin levels and TNF-antagonists serum through levels was observed. Calprotectin emerges as a very useful biomarker to detect residual inflammatory activity in these patients.


Disclosure:

J. Inciarte-Mundo,

Premi Fi de Residencia “Emili Letang”,

2,

Beca MSD Societat Catalana de Reumatologia,

2;

M. V. Hernández,
None;

S. Cabrera-Villalba,
None;

J. Ramirez,
None;

A. Cuervo,
None;

V. Ruiz-Esquide,
None;

A. González Navarro,
None;

J. Yagüe,
None;

J. D. Cañete,
None;

R. Sanmarti,

unrestricted educational grant from Pfizer,

2.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/calprotectin-serum-levels-reflect-residual-inflammatory-activity-in-patients-with-rheumatoid-arthritis-and-psoriatic-arthritis-on-clinical-remission-or-low-disease-activity-undergoing-tnf-antagonists/

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