Predicting response to anti-TNF treatment in rheumatoid arthritis patients

Fabiola Atzeni, Marco Antivalle, Francesca Bobbio Pallavicini, Roberto Caporali, Chiara Bazzani, Roberto Gorla, Ennio Giulio Favalli, Antonio Marchesoni, Piercarlo Sarzi-Puttini

Research output: Contribution to journalArticle

Abstract

Objective: To identify the clinical factors predicting failure or a good clinical response in the cohort of RA patients entered in the Lombardy Rheumatology Network (LORHEN) registry after 3 years of treatment with anti-TNF agents. Methods: We studied the patients who had received anti-TNF agents and been followed up for a minimum of 6 months. Disease activity at baseline and after 6 months was assessed using the DAS28, and response was evaluated according to the EULAR improvement criteria. Results: 1005 patients (55.72 years) were included in the analysis. at baseline the DAS-28 was 5.91 ± 0.95 and a HAQ score was 1.46 ± 0.61. At mean of 14.57 months, 29.9% of the patients achieved a DAS-28 of ≤ 2.6 (remission). A higher RR for remission was associated with male gender (AHR 1.51, 95% CI 1.14-2.00; p: 0.004) and a lower RR for remission with: prior treatment with > 3 DMARDs (AHR 0.077, 95% CI 0.58-1.03; p: 0.074), a high ESR (AHR 0.86, 95% CI 0.81-0.92; p: 0.000), Steinbrocker's functional class III/IV (AHR 0.66, 95% CI 0.48-0.90; p: 0.010), a high TJC (AHR 0.97, 95% CI 0.94-0.99; p: 0.011). A 12-month EULAR non-response was observed in 153/821 (18.6%) associated with a higher baseline HAQ score (AOR 1.51, 95% CI 1.03-2.20, p: 0.033), prior treatment with > 3 DMARDs (AOR 1.76, 95% CI 1.09-2.85; p: 0.021) and corticosteroid > 5 mg/day (AOR 2.05, 95% CI 1.06-3.97; p: 0.034). Conclusion: We found that only a minority of patients with long-standing RA treated with anti-TNF agents achieve a good clinical response or remission.

Original languageEnglish
Pages (from-to)431-437
Number of pages7
JournalAutoimmunity Reviews
Volume8
Issue number5
DOIs
Publication statusPublished - Mar 2009

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amsonic acid
ametantrone
Rheumatoid Arthritis
Antirheumatic Agents
Therapeutics
Rheumatology
Registries
Adrenal Cortex Hormones

Keywords

  • Anti-TNF
  • DAS-28 response
  • EULAR response
  • Factor predictors
  • LORHEN registry

ASJC Scopus subject areas

  • Immunology
  • Immunology and Allergy

Cite this

Predicting response to anti-TNF treatment in rheumatoid arthritis patients. / Atzeni, Fabiola; Antivalle, Marco; Pallavicini, Francesca Bobbio; Caporali, Roberto; Bazzani, Chiara; Gorla, Roberto; Favalli, Ennio Giulio; Marchesoni, Antonio; Sarzi-Puttini, Piercarlo.

In: Autoimmunity Reviews, Vol. 8, No. 5, 03.2009, p. 431-437.

Research output: Contribution to journalArticle

Atzeni, F, Antivalle, M, Pallavicini, FB, Caporali, R, Bazzani, C, Gorla, R, Favalli, EG, Marchesoni, A & Sarzi-Puttini, P 2009, 'Predicting response to anti-TNF treatment in rheumatoid arthritis patients', Autoimmunity Reviews, vol. 8, no. 5, pp. 431-437. https://doi.org/10.1016/j.autrev.2009.01.005
Atzeni, Fabiola ; Antivalle, Marco ; Pallavicini, Francesca Bobbio ; Caporali, Roberto ; Bazzani, Chiara ; Gorla, Roberto ; Favalli, Ennio Giulio ; Marchesoni, Antonio ; Sarzi-Puttini, Piercarlo. / Predicting response to anti-TNF treatment in rheumatoid arthritis patients. In: Autoimmunity Reviews. 2009 ; Vol. 8, No. 5. pp. 431-437.
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AU - Bazzani, Chiara

AU - Gorla, Roberto

AU - Favalli, Ennio Giulio

AU - Marchesoni, Antonio

AU - Sarzi-Puttini, Piercarlo

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N2 - Objective: To identify the clinical factors predicting failure or a good clinical response in the cohort of RA patients entered in the Lombardy Rheumatology Network (LORHEN) registry after 3 years of treatment with anti-TNF agents. Methods: We studied the patients who had received anti-TNF agents and been followed up for a minimum of 6 months. Disease activity at baseline and after 6 months was assessed using the DAS28, and response was evaluated according to the EULAR improvement criteria. Results: 1005 patients (55.72 years) were included in the analysis. at baseline the DAS-28 was 5.91 ± 0.95 and a HAQ score was 1.46 ± 0.61. At mean of 14.57 months, 29.9% of the patients achieved a DAS-28 of ≤ 2.6 (remission). A higher RR for remission was associated with male gender (AHR 1.51, 95% CI 1.14-2.00; p: 0.004) and a lower RR for remission with: prior treatment with > 3 DMARDs (AHR 0.077, 95% CI 0.58-1.03; p: 0.074), a high ESR (AHR 0.86, 95% CI 0.81-0.92; p: 0.000), Steinbrocker's functional class III/IV (AHR 0.66, 95% CI 0.48-0.90; p: 0.010), a high TJC (AHR 0.97, 95% CI 0.94-0.99; p: 0.011). A 12-month EULAR non-response was observed in 153/821 (18.6%) associated with a higher baseline HAQ score (AOR 1.51, 95% CI 1.03-2.20, p: 0.033), prior treatment with > 3 DMARDs (AOR 1.76, 95% CI 1.09-2.85; p: 0.021) and corticosteroid > 5 mg/day (AOR 2.05, 95% CI 1.06-3.97; p: 0.034). Conclusion: We found that only a minority of patients with long-standing RA treated with anti-TNF agents achieve a good clinical response or remission.

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