Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Biomarkers Predictors of Good EULAR Response to B Cell Depletion Therapy (BCDT) in Seropositive Rheumatoid Arthritis Patients.

Ferraccioli3,  Gianfranco, Tolusso3,  Barbara, Pallavicini4,  Francesca Bobbio, Gremese3,  Elisa, Ravagnani1,  Viviana, Benucci5,  Maurizio, Podesta'2,  Edoardo

Department of Clinical and Experimental Medicine, Section of Rheumatology & Internal Medicine, University of Verona, Verona, Italy
Division of Clinical Immunology and Rheumatology, S. Andrea University Hospital, "Sapienza" University of Rome, II School of Medicine, Rome, Italy
Division of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy
Division of Rheumatology, University of Pavia, IRCCS S. Matteo Foundation, Pavia, Italy
Rheumatology Unit, Department of Internal Medicine, Ospedale di S. Giovanni di Dio, Florence, Italy
Rheumatology Unit, University Hospital L. Sacco, Milan, Italy

Background:

The best predictor of a good response to BCDT in Rheumatoid Arthritis (RA) is IgM rheumatoid factor (RF) positivity. No data are available on which biomarkers can identify the best profile of a good responder to BCDT in strictly seropositive RA patients.

Objective:

To define possible biomarkers of a 6th months good EULAR response in RA patients strictly seropositive for one or more autoantibodies.

Methods:

One hundred and forty eight RA patients (122 female; disease duration: 13.0±10.6 years) who did not respond to previous DMARDs and/or TNF-a blockers were enrolled in a multicentric Italian study to evaluate the efficacy of BCDT. All the RA patients were seropositive to at least one of the Autoantibodies (AAB) tested: RF IgG, RF IgM, RFIgA, anti-CCP2 and anti-MCV (Axis-Shield and Orgentec Diagnostika GmbH). At baseline and every 3 months, demographic, clinical, previous TNF blocker therapies and current therapy with glucocorticoids (GC), immunological and laboratory data, HAQ, DAS score were recorded. Plasma levels of IL6 and BAFF were determined at baseline with ELISA methods. A logistic regression models was evaluated to determine the influence of the independent variables that reached the value of p<0.25 at the univariate analysis, considering the optimal cut-off value resulted by the analysis with receiver operating characteristic (ROC) curves on the dependent variable "good EULAR response at 6th month". A p value at the 0.05 level was accepted as statistically significant.

Results:

74.7% of RA patients were positive for anti-CCP2 antibodies, 79.5% for RF IgG, 63.0% for RF IgM, 53.7% for RF IgA, 88.4% for anti-MCV; 10.1%, 12.2%, 18.2%, 23.0% and 36.5% of RA patients were positive for 1, 2, 3, 4, 5 AAB, respectively. 73.7 % of the patients had been treated with one or more TNFa-blockers and 78.9% were on steroid therapy. A EULAR good response was obtained in 23.9% of subjects at the 6th month FU visit.

On multivariate analysis, "EULAR good response to BCDT after 6th months FU" was closely correlated with baseline lymphocytes count <1875/uL (OR (95% CI): 5.78 (1.56–21.45)), RF IgG levels > 52.1 IU/ml (OR (95% CI): 4.48 (1.05–19.24)), plasma BAFF levels < 1011 pg/ml (OR (95% CI): 6.27 (1.13–34.79)) and no current steroid therapy (OR (95% CI): 0.12 (0.03– 0.51)).

Discussion:

Two easy markers (no current steroids and a low lymphocyte count) and two immunological parameters (high RF IgG and low plasma BAFF levels) identify the best responder to BCDT. Data support the original theory that IgG RF could be the main driver of the AAB mediated rheumatoid inflammation.

To cite this abstract, please use the following information:
Ferraccioli, Gianfranco, Tolusso, Barbara, Pallavicini, Francesca Bobbio, Gremese, Elisa, Ravagnani, Viviana, Benucci, Maurizio, et al; Biomarkers Predictors of Good EULAR Response to B Cell Depletion Therapy (BCDT) in Seropositive Rheumatoid Arthritis Patients. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1098
DOI: 10.1002/art.28865

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