Background We previously reported that immunological parameters can predict 6 month response to treatment in early rheumatoid arthritis independently of the drug received. Normal naïve CD4 T cells frequency, notably predicted patient ability to achieve remission. The aim of the current study is to determine whether T cell subset analysis (within 4 h of blood collection) can predict remission and/or lack of response to methotrexate (MTX) followed by MTX-escalation and/or addition of other disease-modifying antirheumatic drugs (DMARDs) with the aim of inducing remission (treat to target concept).
Methods 28 patients with <12 months EIA were recruited and treated with initial MTX-protocol. Clinical response was evaluated using DAS28 at 6 and 12 months. Symptom duration, C reactive protein (CRP), rheumatoid factor (RF), anticitrullinated peptide antibody (ACPA), disease activity score 28 (DAS28) were recorded. 6 colour flow cytometry was performed using standard protocols. Another 31 patients with similar characteristics were randomized to treatment with MTX+TNF-inhibitor (TNF-i)
Results 14/28 patients (50%) achieved remission (DAS28<2.6) when treated under the MTX ‘treat to target’ protocol at both 6 and 12 months. 7patients (25%) showed no response (<1.2 improvement of DAS28) at 6 months and 8 (28%) at 12 months. CRP, symptom duration, RF or ACPA were not associated with either induction of remission or no-response. The only predictor of remission at 6 month was higher naïve T-cell frequency at baseline (p<0.0001) with trends (p=0.150) at 12 months for both naïve T cells and DAS28. Lack of response (<1.2 reduction of DAS28) at 6 months was associated with baseline higher DAS28 (p=0.048) and higher IRC (p=0.050) but with no predictor at 12 months.
Responses from the 31 patients in the TNF-I group were: 14 (45%) patients achieved remission at 6 months and 18 (58%) at 12 months Only one patients did not respond at 6 months but 4 (13%) at 12 months. No single predictor of remission or lack of response could be found in this group.
Six patients in this TNF-i group combined the lack of response to MTX-prognostic factors (IRC>3% and DAS28>4 at baseline. Only one achieved remission at 6 months.
Seven patients treated with TNF-i lacked the good MTX-prognostic factors (naïve T cell<35% and DAS28<4): 3 achieved remission at 6 months and 4 (57%) at 12 months.
Conclusion These data are preliminary however they suggested that, in patients that lack good MTX-prognostic factors, the use of TNF-inhibitor may improve remission rate. They further confirmed previous findings and suggest that transferring flow cytometry protocols from a research lab to routine hospital service may be useful.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.