Anti-citrullinated protein antibody titre as a predictor of abatacept treatment persistence in patients with rheumatoid arthritis: a prospective cohort study in Japan
Anti-citrullinated protein antibody titre as a predictor of abatacept treatment persistence in patients with rheumatoid arthritis: a prospective cohort study in Japan
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DOI：
10.1080/03009742.2019.1627411
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发表时间：
2019-08-10
影响因子：
2.1
通讯作者：
Kawakami, A.
中科院分区：
文献类型：
--
作者：
Endo, Y.;Koga, T.;Kawakami, A.
目的：类风湿关节炎（RA）的成功结局取决于疾病早期的治疗效果及其可持续性。因此，确定预测阿巴西普等生物制剂治疗持久性的因素至关重要。我们比较了持续性RA患者和停止阿巴西普治疗患者的临床特征，包括3个月时自身抗体滴度的早期变化。方法：我们前瞻性地招募了71名和78名分别接受阿巴西普和肿瘤坏死因子抑制剂（TNF-1）治疗的活动性RA患者，这些患者既往曾接受过缓解疾病的抗风湿药物治疗失败。根据阿巴西普或TNF-I从治疗开始至少持续12个月的持续性，比较了非继续治疗组和继续治疗组之间的临床特征。结果如下：在阿巴西普治疗的持续组中，在3个月时观察到类风湿因子滴度和抗瓜氨酸化蛋白自身抗体（ACPA）滴度的显著较大降低，并且在多变量分析中，ACPA滴度的早期降低仍然是阿巴西普持续存在的显著和独立的预测因子。此外，我们从包括基线ACPA滴度和3个月时ACPA滴度降低的模型中获得了0.904的受试者操作特征曲线下面积。12个月时RA疾病活动度评分的持续降低与3个月时ACPA滴度的降低显著独立相关。结论：阿巴西普的持久性和持续的治疗反应与ACPA滴度的早期降低有关。阿巴西普持续和疗效的预测将有助于RA早期治疗的最佳设计。
Objective: Successful rheumatoid arthritis (RA) outcome depends on treatment efficacy in the early stages of the disease and its sustainability. It is thus critical to identify factors predicting treatment persistence with biological agents, such as abatacept. We compared clinical profiles, including early changes in autoantibody titres at 3 months, between patients with RA demonstrating sustained persistence and those discontinuing abatacept treatment. Method: We prospectively enrolled 71 and 78 active RA patients treated with abatacept and tumour necrosis factor inhibitors (TNF-Is), respectively, who had previous disease-modifying anti-rheumatic drug) failure. Clinical characteristics were compared between non-continuation and continuation groups stratified according to abatacept or TNF-I persistence for at least 12 months from treatment initiation. Results: Significantly larger decreases in rheumatoid factor titre and anti-citrullinated protein autoantibody (ACPA) titre were observed in the continuation group of abatacept therapy at 3 months, and early reduction in ACPA titre remained a significant and independent predictor of sustained persistence with abatacept in multivariate analysis. In addition, we obtained the area under the receiver operator characteristics curve of 0.904 from a model including baseline ACPA titre and reduction of ACPA titre at 3 months. Sustained reduction of RA disease activity score at 12 months was significantly and independently associated with reduced ACPA titre at 3 months. Conclusions: Persistence with abatacept and sustained therapeutic response are associated with an early reduction in ACPA titre. Prediction of abatacept continuation and efficacy will facilitate the optimal design of therapy in the early stages of RA.