ANA Indicative of Poor Response to bDMARDs in RA

Development of antinuclear antibodies (ANA) could indicate poor response in patients with rheumatoid arthritis (RA) undergoing treatment with biological disease-modifying antirheumatic drugs (bDMARDs), according to a study published in Seminars in Arthritis and Rheumatism.

In this prospective single-center cohort study, patients with RA were recruited to determine associations between treatment response and ANA development, during treatment with bDMARDs (n=657) or without bDMARDs (n=211). Infliximab (IFX), etanercept, adalimumab, golimumab, certolizumab-pegol, tocilizumab (TCZ), and abatacept (ABT) were included as the bDMARDs evaluated. Investigators requested routine serial ANA profiles every 3 months along with treatment histories and clinical data. ANA levels of more than 1:80 were considered positive; development of ANA was defined as >2 times that of baseline values. Statistical analysis was performed to determine the correlation between the variables and insufficient response to bDMARDs, baseline ANA levels, or ANA development.

ANA development within a year of bDMARDs treatment was significantly associated with insufficient response (odds ratio [OR], 2.68; 95% CI, 1.55-4.65; P =.00044). When analyzed at 3 months and 12 months, investigators found that ANA development at 3 months was significantly associated with insufficient response (OR, 3.51; 95% CI, 1.21-10.2; P =.02). Patients who did develop ANA within a year but not at 3 months demonstrated a significant association with treatment failure between 12 and 24 months (OR, 3.16; 95% CI, 1.06-9.39; P =.0038). Upon deeper analysis, the use of TNF-α inhibitors (TNFi), especially IFX, was revealed to be a significant risk for ANA development within a year. Non-TNFi bDMARDs (TCZ and ABT) were not associated with ANA development.

This study was potentially limited by its design which involved only a single center cohort of Japanese patients with RA.

These findings indicate that there is a strong association between ANA development during bDMARDs treatment and poor future treatment outcomes. In patients with RA who are being treated with bDMARDs, clinical monitoring of ANA could be a predictive tool for later poor treatment outcomes.

Reference

Ishikawa Y, Hashimoto M, Ito H, et al. Anti-nuclear antibody development is associated with poor treatment response to biological disease-modifying anti-rheumatic drugs in patients with rheumatoid arthritis [published online Feb 10, 2019]. Semin Arthritis Rheum. doi: 10.1016/j.semarthrit.2019.02.003