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Calprotectin levels predicts relapse in patients with RA, PsA treated with TNF inhibitors
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Baseline calprotectin serum levels independently predict disease relapse in patients with rheumatoid arthritis and psoriatic arthritis who have achieved remission or low disease activity, according to findings published in Arthritis Research & Therapy.
“Our research group has demonstrated that serum calprotectin stratifies disease activity more accurately than C-reactive protein or the erythrocyte sedimentation rate in patients receiving tumor necrosis factor inhibitors or tocilizumab, and strongly correlates with power Doppler ultrasound synovitis in RA and PsA patients with low disease activity,” José Inciarte-Mundo, PhD, of the University of Barcelona, and colleagues wrote.
The researchers noted that “in other rheumatic diseases, such as juvenile idiopathic arthritis, calprotectin more accurately predicted relapse in patients in remission; therefore, calprotectin might be useful in predicting relapse in RA and PsA patients with low disease activity.”
To evaluate the accuracy of serum calprotectin levels, drug trough serum levels and power doppler score as predictors of relapse in patients with RA and PsA in remission or with low disease activity, who are also receiving TNF inhibitors, Inciarte-Mundo and colleagues conducted a longitudinal, prospective study of 103 patients at the University of Barcelona Hospital Clinic. Participants in the 1-year, single-center study included 47 patients with RA and 56 with PsA. All were receiving TNF inhibitors and were in remission or had low disease activity, defined as a DAS28 of3.2 or less.
To determine the predictive value of serum calprotectin, TNF inhibitor trough serum level and power doppler score, the researchers conducted receiver operating characteristic analyses. They constructed Kaplan-Meier curves from baseline to relapse, and determined associations between baseline factors and relapse using Cox regression models. In addition, Inciarte-Mundo and colleagues developed multivariate models to evaluate the effect of covariates and to fully adjust the association between calprotectin, TNF inhibitor trough serum levels and power doppler score with relapse.
According to the researchers, at baseline, patients who relapsed demonstrated higher calprotectin levels, lower TNF inhibitor trough serum levels and higher power doppler activity than those who did not. In addition, receiver operating characteristic analysis revealed that serum calprotectin predicted relapse, with an area under the curve (AUC) of 1. TNF inhibitor trough serum level and power doppler had an AUC of 0.79 (95% CI; 0.691-0.889) and 0.877 (95% CI; 0.772–0.981), respectively.
Survival analyses and logarithmic rank tests demonstrated significant differences between groups according to calprotectin serum levels (P<.001), TNF inhibitor trough serum level (P=.004) and power doppler score (P <.001).
The researchers further found, using univariate Cox regression models, that time-to-remission and low disease activity (HR=1.17; P <.001), calprotectin levels (HR=2.38; P<.001), TNF inhibitor trough serum level (HR=0.47; P=.018) and power doppler score (HR=1.31; P<.001) were significantly associated with disease relapse. However, following multivariate analysis, only baseline calprotectin levels independently predicted relapse (HR=2.41; P=.002).
“In RA and PsA patients with low levels of disease activity, time-to-remission/low disease activity, calprotectin serum levels, TNF [inhibitor] trough serum levels and [power Doppler] score were significantly associated with disease relapse,” Inciarte-Mundo and colleagues wrote. “However, only baseline calprotectin levels were independently associated with disease relapse. Calprotectin may be used to stratify disease activity more accurately in patients with low disease activity, guiding therapeutic decisions towards safer and more cost-effective strategies.” – by Jason Laday
Disclosure: Inciarte-Mundo reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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