Background Biomarkers complementing clinical evaluations may help to reduce the length and size of proof-of-concept (PoC) trials aimed to obtain quick “go/no go” decisions in the clinical development of new treatments.
Objectives We aimed to identify and validate serum biomarkers to predict clinical response in spondyloarthritis (SpA) PoC trials.
Methods The candidate biomarkers high sensitive-C-reactive protein (hs-CRP), interleukin-6 (IL-6), pentraxin-3 (PTX-3), alpha-2-macroglobulin (alpha-2-MG), matrix metalloproteinase-3 (MMP-3), calprotectin, and Vascular Endothelial Growth Factor (VEGF) were determined by ELISA in healthy controls (n=20) and SpA patients before and after 2 weeks of infliximab (n=18) or placebo (n=19) treatment. Clinical outcome was evaluated at week 12. Results were validated in ankylosing spondylitis (AS) with infliximab and peripheral SpA with etanercept.
Results Serum levels of calprotectin, hs-CRP, PTX-3, VEGF (all P<0.001) and MMP-3 (P=0.062), but not IL-6 and alpha-2-MG, were increased in SpA versus healthy controls. Treatment with infliximab, but not placebo, significantly decreased calprotectin (P<0.001) and hs-CRP (P<0.001) levels, with a similar trend for MMP-3 (P=0.063). The Standardized Response Mean (SRM), which reflects the ability to detect changes over time, was high for calprotectin (1.26), good for hs-CRP (0.96) and moderate for MMP-3 (0.52). Calprotectin and hs-CRP, but not MMP-3, were good biomarkers of treatment response in axial SpA as evaluated in 2 separate cohorts. All 3 markers reflected response to etanercept treatment in peripheral SpA with SRMs above 0.5.
Conclusions Calprotectin and hs-CRP are good serum biomarkers to predict clinical response at the group level in small-scale, short term PoC trials in SpA.
Disclosure of Interest M. Turina: None declared, N. Yeremenko: None declared, J. Paramarta: None declared, L. De Rycke: None declared, D. Baeten Grant/research support: AbbVie, Centocor, Janssen-Cilag, MSD, Novartis, and Pfizer, Consultant for: AbbVie, BMS, Boehringer Ingelheim, Centocor, Janssen, MSD, Novartis, Pfizer, and UCB
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