Favorable clinical response and drug retention of anti-IL-6 receptor inhibitor in rheumatoid arthritis with high CRP levels: the ANSWER cohort study.

Abstract

OBJECTIVE:

Currently, biological disease-modifying anti-rheumatic drugs (bDMARDs) with different modes of action [tumour necrosis factor inhibitor (TNFi), interleukin-6 receptor inhibitor (IL-6Ri), or cytotoxic T-lymphocyte antigen 4-immunoglobulin (CTLA4-Ig)] are used in clinical practice to treat rheumatoid arthritis (RA). However, it is unclear which type of bDMARD is the most efficacious for a specific clinical situation. C-reactive protein (CRP) is an acute-phase reactant driven by IL-6 signalling. Here, we aimed to establish whether therapeutic efficacy differs between IL-6Ri and other bDMARDs with alternative modes of action in RA patients according to their CRP level.

METHOD:

RA patients treated with bDMARDs were enrolled from an observational multicentre registry in Japan. Patients were classified into three groups according to baseline CRP tertiles. The overall 3 year retention rates of each bDMARD category were assessed. The Clinical Disease Activity Index (CDAI) was also assessed before and 3, 6, and 12 months after bDMARD initiation.

RESULTS:

A total of 1438 RA patients were included and classified into three groups according to tertiles of baseline CRP levels (CRP1, 0-0.3; CRP2, 0.3-1.8; CRP3, 1.8-18.4 mg/dL). In CRP3, the overall 3 year drug retention rates were significantly higher for IL-6Ri than for TNFi and CTLA4-Ig (77.5 vs 48.2 vs 67.3, respectively). No significant difference was evident in terms of CDAI 12 months after bDMARD initiation in CRP1-CRP3.

CONCLUSION:

IL-6Ri may be a favourable therapeutic option over TNFi and CTLA4-Ig in RA patients with high CRP levels.

• Authors: Y Nakayama, M Hashimoto, R Watanabe, K Murakami, K Murata, M Tanaka, H Ito, W Yamamoto, K Ebina, K Hata, Y Hiramatsu, M Katayama, Y Son, H Amuro, K Akashi, A Onishi, R Hara, K Yamamoto, K Ohmura, S Matsuda, A Morinobu
• Journal: Scandinavian journal of rheumatology (Scand J Rheumatol) Vol. 51 Issue 6 Pg. 431-440 (Nov 2022) ISSN: 1502-7732 [Electronic] England
• PMID: 34511031 (Publication Type: Journal Article)

Chemical References

• Abatacept
• Antirheumatic Agents
• Tumor Necrosis Factor Inhibitors
• Antibodies

Topics

• Humans
• Abatacept (therapeutic use)
• Cohort Studies
• Arthritis, Rheumatoid (drug therapy)
• Antirheumatic Agents (therapeutic use)
• Tumor Necrosis Factor Inhibitors
• Antibodies
• Treatment Outcome