Background We reported that the presence of anti-Ro/SS-A antibody (anti-Ro) in rheumatoid arthritis (RA) patients might be related to the inefficacy and the discontinuation of infliximab (IFX) compared to the other TNF inhibitors (etanercept and adalimumab). In addition, anti-Ro-positive patients who did not respond to IFX or adalimumab improved clinically when they switched to etanercept or tocilizmab (TCZ) as the second biologics.
Objectives To study the difference in clinical response between anti-Ro-positive and -negative RA patients treated with golimumab (GLM) that is one of the TNF inhibitors and TCZ that is IL-6 inhibitor.
Methods Thirty-six patients with GLM treatment (naïve: 15, switch: 21) and 38 patients with TCZ treatment (naïve: 7, switch: 31) were studied the efficacy and the continuation rate. The baseline characteristics were compared between responders and non-responders. Clinical response according to the disease activity score in 28 joints (DAS28) EULAR response criteria at 24 and 48 weeks was compared between anti-Ro-positive and -negative patients with RA.
Results The EULAR response of a moderate or good response at 24 weeks based on DAS28 score in GLM and TCZ treatment was 29/36 (80.6%) and 35/38 (85.7%), respectively. There was revealed similar pattern at 48 weeks both GLM and TCZ treatment (82.1% and 94.7%, respectively). The following variables at baseline that were sex, age, disease duration, methotrexate dose, steroid dose, CRP levels, ESR levels, and DAS28 were not different between responders and non-responders in both GLM and TCZ treatment. When the clinical efficacy was compared between naïve and switch patients, the number of responders to TCZ treatment was not different between naïve and switch (85.7% to 93.5%, respectively), while the response to GLM in naïve was significantly higher than that in switch (100% to 65%; respectively, p=0.013). Anti-Ro was detected in 7 of 36 (19.4%) patients with GLM treatment, and detected in 10 of 38 (26.3%) patients with TCZ treatment. When we focused on the presence of anti-Ro, the EULAR response of a moderate or good response was not different between anti-Ro-positive and -negative patients treated with both GLM and TCZ at 24 and 48 weeks (24 weeks: GLM; 85. 7% vs. 70.4%; respectively, p=1.000, TCZ; 100% vs. 89.3%, respectively, p=0.552, 48 weeks: GLM; 71.4% vs. 70.4%; respectively, p=1.000, TCZ; 100% vs. 92.9%; respectively, p=1.000). The continuation rate to GLM and TCZ in anti-Ro-positive patients were 74.4% and 90.0%, respectively.
Conclusions There was no difference efficacy between anti-Ro-positive and -negative RA patients with both treatments. The efficacy and the continuation rate of TCZ were better than that of GLM, in RA patients with both switched bio and anti-Ro. On the other hand, GLM was effective in RA patients with anti-Ro and it was suggested that the results might be related to the different immunogenicity between GLM and IFX.
Matsudaira R,et al. Anti-Ro/SS-A antibodies are an independent factor associated with an insufficient response to tumor necrosis factor inhibitors in patients with rheumatoid arthritis. J Rheumatol 2011; 38: 2346-54
Van Schouwenburg PA, et al. Immunogenicity of anti-TNF biologic therapies for rheumatoid arthritis. Nat Rev Rheumatol 2013; 9: 164-72
Disclosure of Interest None declared