Anti-Ro/SSA Antibodies Are an Independent Factor Associated with an Insufficient Response to Tumor Necrosis Factor Inhibitors in Patients with Rheumatoid Arthritis
Anti-Ro/SSA Antibodies Are an Independent Factor Associated with an Insufficient Response to Tumor Necrosis Factor Inhibitors in Patients with Rheumatoid Arthritis
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DOI：
10.3899/jrheum.101295
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发表时间：
2011-11-01
影响因子：
3.9
通讯作者：
Takasaki, Yoshinari
中科院分区：
文献类型：
--
作者：
Matsudaira, Ran;Tamura, Naoto;Takasaki, Yoshinari
目标。目的探讨抗ro /SSA抗体（anti-Ro）在类风湿关节炎（RA）患者对肿瘤坏死因子（TNF）抑制剂临床反应中的意义。190名RA患者接受英夫利昔单抗、依那西普或阿达木单抗（n = 112、64和14）作为首批生物制剂治疗的临床反应，在24周时使用28个关节的疾病活动评分（DAS28）和56周时的停药率进行检查。比较有反应者和无反应者的基线特征。比较抗o阴性和抗o阳性患者的临床反应。用多变量logistic回归分析估计与TNF抑制剂无效相关的因素。在24周无欧洲抗风湿病联盟（EULAR）反应的患者中，抗ro阳性率明显更高（OR 3.64, 95% CI 1.45-9.01, p = 0.003）。在抗o阳性患者中，中度或良好的EULAR反应率显著降低，持续较高的中位DAS28 (p = 0.006)，而在英夫利昔单抗治疗的患者中，这种差异更大。抗o阳性患者在56周时因TNF抑制剂无效而停药的比例也更高（OR 4.68, 95% CI 1.82-11.99, p = 0.0005），其中75%的患者接受了英夫利昔单抗治疗。抗ro的存在与24周无ular反应和56周TNF抑制剂停药率较高密切相关（OR 5.22, 95% CI 1.75-15.57, p = 0.003; OR 10.18, 95% CI 2.18-49.56, p = 0.003）。与其他TNF抑制剂相比，抗- ro的存在可能与英夫利昔单抗较低的临床反应有关，提示在为RA患者选择合适的生物制剂时应考虑抗- ro的存在。（首次发布2011年10月1日；journal Rheumatol 2011;38:2346-54; doi:10.3899/ jrheumat. 101295）
Objective. To study the significance of anti-Ro/SSA antibodies (anti-Ro) in the clinical response to tumor necrosis factor (TNF) inhibitors in patients with rheumatoid arthritis (RA).Methods. The clinical responses of a cohort of 190 patients with RA who were treated with infliximab, etanercept, or adalimumab (n = 112, 64, and 14, respectively) as the first biologics were examined using the Disease Activity Score in 28 joints (DAS28) at 24 weeks and the discontinuation rate at 56 weeks. The baseline characteristics of responders and the nonresponders were compared. The clinical response was compared between anti-Ro-negative and -positive patients. The factors associated with the inefficiency of TNF inhibitors were estimated with a multivariable logistic regression analysis.Results. The positive rate of anti-Ro was significantly higher in patients with no European League Against Rheumatism (EULAR) response at 24 weeks (OR 3.64, 95% CI 1.45-9.01, p = 0.003). In anti-Ro-positive patients, a moderate or good EULAR response rate was significantly lower with a sustaining higher median DAS28 (p = 0.006), and this difference was greater among infliximab-treated patients. The discontinuation rate for TNF inhibitors due to inefficacy at 56 weeks was also higher in anti-Ro-positive patients (OR 4.68, 95% CI 1.82-11.99, p = 0.0005), and 75% of these patients received infliximab. The presence of anti-Ro was strongly associated with no EULAR response at 24 weeks and a higher discontinuation rate of TNF inhibitors by 56 weeks (OR 5.22, 95% CI 1.75-15.57, p = 0.003 and OR 10.18, 95% CI 2.18-49.56, p = 0.003).Conclusion. The presence of anti-Ro might be related to the lesser clinical response to infliximab compared to other TNF inhibitors, suggesting that the presence of anti-Ro should be considered when choosing the appropriate biologics for patients with RA. (First Release Oct 1 2011; J Rheumatol 2011;38:2346-54; doi:10.3899/jrheum.101295)