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Early RA treatment responders have reduced anti-citrullinated peptide antibodies
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Patients newly diagnosed with rheumatoid arthritis who responded to treatment with methotrexate and later add-on therapies showed reductions in anti-citrullinated peptide antibodies and had less radiographic progression than non-responders, according to new research.
Researchers selected 316 patients with early rheumatoid arthritis (RA) who were enrolled in the Swedish Pharmacotherapy trial and for whom baseline and 3-month serum samples were available to analyze for antibodies against cyclic citrullinated peptides (CCPs) and citrullinated peptides derived from vimentin (cVim), fibrinogen (cFib) and alpha-enolase (CEP-1).
Patients began monotherapy with methotrexate. Those who did not respond well to treatment after 3 months were randomly assigned to add-on therapy with the disease-modifying anti-rheumatic drugs (DMARDs), sulfasalazine and hydroxychloroquine, or the anti-tumor necrosis factor (anti-TNF) drug, infliximab. The researchers assessed anti-citrullinated peptide antibodies (ACPAs) again in this cohort at 12 and 24 months.
Results showed that by 2-year follow-up, the proportion of patients who tested positive for cVim, cFib and Cep-1 antibodies had decreased significantly, whereas the occurrence of anti-CCP antibodies remained stable, according to the researchers.
The researchers also found that the reduction of anti-cVim antibodies during the first 3 months was associated with reduced radiographic progression of RA symptoms at 2 years. The results were similar after adjusting for baseline joint damage and smoking status.
Patients who tested positive for two ACPAs had lower disease progression than those who tested positive for four ACPAs. No significant difference was seen in antibodies between patients receiving add-on DMARDs or anti-TNF therapies during months 3 to 12, according to the researchers.
Disclosures: Petersson participates in the speakers bureau for UCB Pharma, AbbVie and Pfizer. Van Vollenhoven has received grants/research support from AbbVie, BMS, GSK, Pfizer, Roche and UCB Pharma, and consultancy/honoraria from AbbVie, Biotest, BMS, GSK, Janssen, Lilly, Merck, Pfizer, Roche, UCB and Vertex. Klareskog had received research grants from AbbVie, BMS, Pfizer, Roche, UCB Pharma, NovoNordisk, Janssen and Sobi. Lundberg is co-inventor of patent US12/524,465, describing the diagnostic use of the CEP-1 epitope. All other authors declare no potentially competing interests.
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