HIGH RATE OF IMPROVEMENT IN SERUM MATRIX METALLOPROTEINASE-3 LEVELS AT 4 WEEKS PREDICT REMISSION AT 52 WEEKS IN RA PATIENTS WITH ADALIMUMAB THERAPY

Background/Purpose : Serum Matrix metalloproteinase-3 (MMP-3) is a specific inflammatory marker of the synovium in patients with rheumatoid arthritis (RA). Our aim in this study is to investigate whether serum MMP-3 is the predictor for remission in treatment for RA patients with biologics.

Methods: All RA patients (n=269) who underwent Adalimumab (ADA) treatment in the multicenter study group (Tsurumai Biologics Communication Registry; TBCR) were enrolled in this study. We analyzed 114 patients in continuation with ADA therapy for 52 weeks. We divided into 2 groups based on the improvement of serum level of MMP-3 and CRP: high rate of improvement (MMP-HR group) and low rate of improvement (MMP-LR group) in serum MMP-3 levels at 4 weeks, and: high rate of improvement (CRP-HR group) and low rate of improvement (CRP-LR group) in serum CRP levels at 4 weeks (Table1). We also divided into 2 groups based on the serum level of MMP-3 and CRP: high value (MMP-H group) and low value (MMP-LR group) in serum MMP-3 levels at 4 weeks, and: high value (CRP-H group) and low value (CRP-L group) in serum CRP levels at 4 weeks (Table2). We evaluated the rate of remission at 24, and 52 weeks in 2 groups.

Results: In patients continuing at 52 weeks, the rate of remission at 24 and 52 weeks in MMP-HR group is 56% and 60%, and MMP-LR group is 32% and 37%. The rate of remission at 24 and 52 weeks in MMP-HR group is significantly higher than in MMP-LR group (Fig.1). However, the rate of remission at 24 and 52 weeks had no significance in CRP-HR group and CRP-LR group (Fig.2).The rate of remission at 24 and 52 weeks in MMP-H group is 35% and 44%, and MMP-L group is 55% and 53%. The rate of remission at 24 weeks in MMP-L group is significantly higher than in MMP-H group (Fig.3). However, the rate of remission at 24 and 52 weeks had no significance in CRP-H group and CRP-L group (Fig.4). Moreover, the rate of remission at 24 and 52 weeks in MMP-(L and HR) group is very high (Fig.5). In patients continuing at 52 weeks, the best cut-off rate of improvement in MMP-3 at 4 weeks for determining remission at 52 weeks was 40% determined by ROC analysis (sensitivity: 47%, specificity: 83%, accuracy: 64%).

Conclusion: We considered that high rate of improvement in serum MMP-3 at 4 weeks can be useful for predicting the remission at 52 weeks in RA patients with ADA therapy.