Background Although anti-cyclic citrullinated peptide (anti-CCP) positivity is regarded as a strong prognostic factor for untreated RA outcome, the benefit of anti-CCP tests for personalized medicine is controversial.1 Illustratively, anti-CCP was not predictive for response to anti-TNF in RA, as shown in meta-analyses, although some predictive value was shown for rituximab.2–4 There are, however, indications that better response to abatacept (ABA) is predicted by anti-CCP positivity.5–7
Objectives To test whether anti-CCP level at baseline (BL) is an independent predictor for treatment response (DAS28 [CRP]-based EULAR response criteria) at 12 months (M) in patients (pts) with RA treated with ABA.
Methods Consenting pts with RA from Radboud UMC and Sint Maartenskliniek were consecutively included if they started treatment with ABA (BL). The anti-CCP values closest before BL were used. DAS28 (CRP) was assessed at BL and at 12M by trained rheumatology nurses or rheumatologists. Demographic and disease-related variables, treatment history and co-morbidity were also assessed. Primary outcome was response to treatment based on DAS28 (CRP) EULAR response criteria at M12. Therapy cessation was regarded as non-response. Multiple imputation with 20 repetitions was used to replace missing predictors. Multivariate logistic regression was used to examine whether anti-CCP positivity was an independent predictor for treatment response, taking confounding BL covariates (Table variables) into account.
Results Data were available for 200 pts with RA starting ABA. Mean (SD) age was 58 (13) years, 165 (83%) were female and median (p25–p75) disease duration was 12 (7–19) years (Table). Overall, 121 (61%) pts were anti-CCP positive at BL. At 12M, 86 (43%) pts remained on ABA. In the univariate model, anti-CCP was a predictor for treatment response (odds ratio 2.51; 95% CI 1.1, 6.0; p=0.038). No relevant confounding was present.
Conclusions Anti-CCP positivity was confirmed as an independent predictor for treatment response at 12M in pts with RA treated with abatacept. As indicated by meta-analysis and systematic reviews, anti-CCP is not predictive for the response to anti-TNFs.2–4 Additional studies are needed to evaluate whether abatacept could be a preferable treatment in anti-CCP-positive pts.
Taylor P, et al. Autoimmune Dis 2011;2011:815038.
Lv Q, et al. PLoS ONE 2014;9:e89442.
Isaacs JD, et al. Ann Rheum Dis 2013;72:329–36.
Cuppen BV, et al. Rheumatology (Oxford) 2016;55:826–39.
Gottenberg JE, et al. Ann Rheum Dis 2012;71:1815–19.
Sokolove J, et al. Ann Rheum Dis 2015;74(Suppl 2):675.
Huizinga TWJ, et al. Ann Rheum Dis 2015;74(Suppl 2):234–5.
Disclosure of Interest A. den Broeder Grant/research support from: CZ, Menzis, ZonMw, Consultant for: Amgen, Boehringer Ingelheim, Speakers bureau: Bristol-Myers Squibb, Pfizer, T. Kerstens: None declared, J. Fransen Grant/research support from: Bristol-Myers Squibb, C. van den Ende: None declared, L. Tweehuysen: None declared, R. Postema Employee of: Bristol-Myers Squibb, E. Alemao Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, F. van den Hoogen Consultant for: Celltrion, Sandoz, Mundipharma and Biogen, Speakers bureau: Celltrion, Sandoz, Janssen, Egis