Background Many efforts have been made to identify biomarkers for therapy response. No single laboratory and clinical marker, with high accurately, allows prediction of TNFα therapy efficacy in individual patient. Numerous studies have shown that anti-cyclic citrullinated peptide (anti-CCP) and rheumatoid factors (RF) are concurrent with other clinical data.
Objectives We assess dynamic of anti-CCPs antibodies and RF also it connection with RA disease activity before and after therapy with anti-TNFα biologics.
Methods A commercially available ELISA kits CCP plus (Euro-Diagnostica) were assessed. Serum samples were collected from all RA patients (diagnosed according ACR criteria). Anti-CCP and RF were measured by the ELISA. Symbols: therapy at baseline (time T1), after 6 months (time T2), 12 months (time T3) and after 18 months (time T4). Anti-CCP2 and RF were found positive in 100% of patients. The sensitivity and specificity of anti-CCP reactivity was 74% and 96% accordingly. We follow up the correlation between anti-CCP antibody also RF and DAS28, ESR, CRP, VAS, prospectively, during therapy with etanercept or adalimumab /plus methotrexate, without corticosteroids/. Comparison variables was performed with t-test or Mann-Whitney
Results Sociodermografic characteristics: 89 consecutive patient with RA, the mean ± SD age was 49.3±12.3 years; man: females -1: 3; disease duration was 47±23 years. BMI (T1) were 29.8±4.2; Anti-CCP at baseline (time T1) was 122.2±103.6 U/ml, after T2 - 79.9±99.9 (p<0.05), after T3 – 68.6±58.9 (p<0.05), after T4 - 14.56±94.7 (p<0.001). There no significant difference between anti-CCP dynamic and RF dynamic (p>0.05). Median values of DAS28 significantly decreased from T1 to 4.1 (3,8-4.4), to T2 - 3.8 (3.6-3,9), to T3 - 3.2 (3.0 -3.4) and to T4 - 2.6 (3.3-2.4), (p<0.001) respectively. ESR at T1 was 45.2 (24-95) mm, and after T2. T3 and T4 respectively was reduced to 22.7 (6-55), 18 (5-33) and 17 (4-27) mm (p<0.001). CRP at T1 was 59.2 (24-95) U/ml, and after T2, T3, T4 was reduced to 22.7 (6-55), 18 (33-5) and 17.5 (4.1-27.9) U/ml, respectively (p<0.001). VAS at baseline (T1) was 40.2 (27-90) mm, and after T2, T3, T4 was change for the better: 22.7 (6-55), 18 (33-5) and 17.5 (11-27.9) mm, (p<0.001). There was a strong positive correlation with decreasing trend (r=0.77 to 0.71) during therapy of etanercept or adalimumab and value of anti-CCP and RF, as well with Das28, CRP, ESR and VAS clinical tests. Changes was marked better after T3 and T4.
Conclusions In RA, therapy with etanercept and with adalimumab decrease the titers of anti-CCP antibody, also the RF value slowly and the same time pointedly DAS28 and laboratory tests, after 12 and 18 months.
Musetesiu AE, Ciurea P, Rosu A. Immunological profile in patients with rheumatoid arthritis and biological therapy HVM bioflux, 2015;7(1):11-16.
Canhao H., Rodrigues AM, Mourao AF, Santos MJ et al. Comparative effectiveness and predictors of response to tumor necrosis factor inhibito therapies in rheumatoid arthritis.Rheumatology Oxford 2012;512020-2026.
Disclosure of Interest None declared