Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: Patients with rheumatoid arthritis (RA) exert a wide variety of therapeutic responses to disease controlling anti-rheumatic drugs (DMARDs). P-glycoprotein (P-Gp) is involved in treatment resistance in some chronic diseases. Although, to date there is lack information to identify if high levels of P-gp are associated with low therapeutic response to s-DMARDs. The aim of the present study is analyze the association between serum P-Gp levels with the severity of disease activity despite treatment with DMARDs in RA.
Methods: We included in this cross-sectional study eighty-one patients with RA treated for at least six months with DMARD. Patients were assessed for disease activity (DAS-28), type of DMARD, as well as other drugs currently used for the treatment of their disease and other clinical characteristics. Serum P-Gp levels were measured by ELISA.
Results: The patients had a mean age of 57±10, the frequency of synthetic DMARDs received by the patients were methotrexate 59%, sulfasalazine 38%, leflunomide 30%, azathioprine 14%, chloroquine 14%, d-penicillamine 3%; whereas anti-TNF agents were received by 11% (etanercept 9%, adalimumab 1%, infliximab 1%) and rituximab 4%. Overall, patients with RA had higher serum P-Gp levels compared with controls 153 ± 187 versus 31 ± 29 ng/mL; respectively, p<0.0001). Patients with moderate or severe disease activity had higher serum P-Gp levels compared with patients with low-disease activity or remission (201 ± 207 versus 109 ± 156 ng/mL; respectively, p=0.028). Serum P-Gp levels were correlated with DAS-28 (r=0.26, p=0.018). There were no differences observed between patients with biologic agents vs patients with synthetic DMARDs in the serum P-Gp levels (228 ± 200 vs. 140 ± 183 ng/mL; p=0.14). P-Gp levels were independent of methotrexate utilization (p=0.5). After adjusting for age, disease duration and biologic agents’ utilization, the serum P-Gp levels remain associated with moderate or severe disease activity in the logistic regression analysis (p=0.021, using forward conditional method)
Conclusion: Higher serum P-Gp levels are associated with the severity of disease activity despite treatment with DMARDs in RA. These serum levels can be used as biomarkers in patients with a non-therapeutic response. Further longitudinal studies should demonstrate if these levels can be predictive of failure to therapeutic response.
To cite this abstract in AMA style:Perez-Guerrero EE, Gamez-Nava JI, Cardona-Muñoz EG, Muñoz-Valle JF, Hernandez-Cuervo P, Bonilla-Lara D, Saldaña-Cruz AM, Fajardo-Robledo NS, Totsuka-Sutto SE, Rincon-Sanchez AR, Cardona-Muller D, Gonzalez-Lopez LDC. Serum Levels of P-Glycoprotein Are Associated with Disease Activity in Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/serum-levels-of-p-glycoprotein-are-associated-with-disease-activity-in-rheumatoid-arthritis/. Accessed December 2, 2020.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/serum-levels-of-p-glycoprotein-are-associated-with-disease-activity-in-rheumatoid-arthritis/