Background The prediction of individual response to biological treatment has become a major clinical challenge in RA. Recent studies have provided evidence that biomarkers may be identified predictive of the response to therapy with these agents1.
Objectives To identify a candidate multi-biomarker score (MB) of response to infliximab (INF), rituximab (RTX) and tocilizumab (TCZ) therapies in RA.
Methods The study cohort included 97 RA patients, 21 starting INF, 27 RTM and 42 TCZ therapies. After 24 weeks, the EULAR criteria were used to classify patients as responders or nonresponders. Good response was achieved by 22.7% for INF, 5.8% for RTM and 16.6% for TCZ. 4 antibodies (IgM RF, IgA RF, anti-CCP, AMCV), 3 inflammation markers (ESR, CRP, calprotectin), 3 markers of bone (sRANKL) and cartilage (COMP, MMP-3) metabolism, 27 cytokines (IL-1β,-1ra,-2,-4,-5,-6,-7,-8,-9,-10,-12,-13,-15, -17, basic FGF, eotaxin, G-CSF, GM-CSF, IFN-γ, IP-10, MCP-1, MIP-1α, MIP-1β, PDGF-BB, RANTES, TNF-α, VEGF) serum concentrationswere measured. Analysis of consistency and confidence as biomarkers of early RA was carried out by multivariate logistic regression.
Results A multi-biomarker scores of response: to INF (MBINF) was calculated based on the concentrations of: IL-17,-12,-9, CRP (AUC 0,96; sensitivity 100%; specificity 75%; LR+ 4; LR- 0, cutoff=0,45); to RTM (MBRTM): VEGF, IL-1ra,-10, G-CSF, IgM RF (AUC 0,99; sensitivity 96%; specificity 99%; LR+ 96; LR- 0,01 cutoff=0,6); to TCZ (MBTCZ): MMP-3, VEGF, anti-CCP (AUC 0,85; sensitivity 80%; specificity 83%; LR+ 4,7; LR- 0,2, cutoff =1,27).
Conclusions All candidate multi-biomarker scores of response to INF, RTX and TCZ therapies in RA demonstrated a good diagnostics performance. After accurate validation, this test could be used in clinical laboratory practice.
Simsek I. Predictors of Response to TNF Inhibitors in Rheumatoid Arthritis - Do We Have New Tools for Personalized Medicine? Bull NYU Hosp Jt Dis. 2012;70(3):187-90.
Disclosure of Interest None Declared