Abstract | OBJECTIVE: To investigate whether the Multi- Biomarker Disease Activity ( MBDA) score predicts optimal add-on treatment in patients with early rheumatoid arthritis (RA) who were inadequate responders to MTX (MTX-IRs). METHODS: We analyzed data from 157 MTX-IRs (with a Disease Activity Score using the erythrocyte sedimentation rate [DAS28-ESR] >3.2) from the Swedish Pharmacotherapy (SWEFOT) trial who were randomized to receive triple therapy (MTX plus sulfasalazine plus hydroxychloroquine) versus MTX plus infliximab. The MBDA score as a predictor of the subsequent DAS28-based response to each second-line treatment was analyzed at randomization with the Breslow-Day test for 2 × 2 groups, using both validated categories (low [<30], moderate [30-44], and high [>44]) and dichotomized categories (lower [≤38] versus higher [>38]). RESULTS: Among the 157 patients, 12% had a low MBDA score, 32% moderate, and 56% high. Of those with a low MBDA score, 88% responded to subsequent triple therapy, and 18% responded to MTX plus infliximab (P = 0.006); for those with a high MBDA score, the response rates were 35% and 58%, respectively (P = 0.040). When using 38 as a cutoff for the MBDA score (29% patients with lower scores versus 71% with higher scores), the differential associations with response to triple therapy versus MTX plus infliximab were 79% versus 44% and 36% versus 58%, respectively (P = 0.001). Clinical and inflammatory markers had poorer predictive capacity for response to triple therapy or MTX plus infliximab. CONCLUSION: In patients with RA who had an inadequate response to MTX, the MBDA score categories were differentially associated with response to subsequent therapies. Thus, patients with post-MTX biochemical improvements (lower MBDA scores) were more likely to respond to triple therapy than to MTX plus infliximab. If confirmed, these results may help to improve treatment in RA.
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Authors | Karen Hambardzumyan, Saedis Saevarsdottir, Kristina Forslind, Ingemar F Petersson, Johan K Wallman, Sofia Ernestam, Rebecca J Bolce, Ronald F van Vollenhoven |
Journal | Arthritis & rheumatology (Hoboken, N.J.)
(Arthritis Rheumatol)
Vol. 69
Issue 5
Pg. 953-963
(05 2017)
ISSN: 2326-5205 [Electronic] United States |
PMID | 27992691
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Copyright | © 2017, The Authors. Arthritis & Rheumatology published by Wiley Periodicals, Inc. on behalf of American College of Rheumatology. |
Chemical References |
- Antirheumatic Agents
- Biomarkers
- CHI3L1 protein, human
- Chitinase-3-Like Protein 1
- IL6 protein, human
- Interleukin-6
- Leptin
- RETN protein, human
- Receptors, Tumor Necrosis Factor, Type I
- Resistin
- Serum Amyloid A Protein
- VEGFA protein, human
- Vascular Cell Adhesion Molecule-1
- Vascular Endothelial Growth Factor A
- Sulfasalazine
- Hydroxychloroquine
- Epidermal Growth Factor
- C-Reactive Protein
- Infliximab
- MMP3 protein, human
- Matrix Metalloproteinase 3
- MMP1 protein, human
- Matrix Metalloproteinase 1
- Methotrexate
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Topics |
- Antirheumatic Agents
(therapeutic use)
- Arthritis, Rheumatoid
(blood, drug therapy)
- Biomarkers
(blood)
- Blood Sedimentation
- C-Reactive Protein
(metabolism)
- Chitinase-3-Like Protein 1
(blood)
- Decision Support Techniques
- Drug Therapy, Combination
- Epidermal Growth Factor
(blood)
- Female
- Humans
- Hydroxychloroquine
(therapeutic use)
- Infliximab
(therapeutic use)
- Interleukin-6
(blood)
- Leptin
(blood)
- Male
- Matrix Metalloproteinase 1
(blood)
- Matrix Metalloproteinase 3
(blood)
- Methotrexate
(therapeutic use)
- Randomized Controlled Trials as Topic
- Receptors, Tumor Necrosis Factor, Type I
(blood)
- Resistin
- Serum Amyloid A Protein
(metabolism)
- Severity of Illness Index
- Sulfasalazine
(therapeutic use)
- Treatment Failure
- Treatment Outcome
- Vascular Cell Adhesion Molecule-1
(blood)
- Vascular Endothelial Growth Factor A
(blood)
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