RESEARCH - Predictors of response to anti-TNF therapy according to ACR and EULAR criteria in patients with established RA

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Rheumatology Advance Access published online on March 3, 2008

Rheumatology, doi:10.1093/rheumatology/ken002

Predictors of response to anti-TNF therapy according to ACR and EULAR

criteria in patients with established RA: results from the South

Swedish Arthritis Treatment Group Register

L. E. sen1, M. C. Kapetanovic1, A. Gülfe1, M. Söderlin2, T.

Saxne1 and P. Geborek1

1Department of Rheumatology, Lund University Hospital, SE-221 85 Lund

and 2Department of Rheumatology, Spenshult, SE-313 92 Oskarström,

Sweden.

Abstract

Objective. To identify factors predicting response to first TNF

blocking treatment course in patients with established RA with a

special focus on gender differences.

Methods. Patients with active RA initiating their first treatment

course of TNF-blocking therapy were enrolled. The study period was

March 1999 through September 2006. The prospective protocol included

information on demographics, clinical characteristics of patients and

response measures. Fulfilment of ACR 50–70% improvement and European

League Against Rheumatism (EULAR) good response or remission [28-joint

disease activity score (DAS28) <2.6] at 3 months were chosen as

primary outcome measures. Potential predictors of responses were

identified using multivariate binary logistic regression models.

Results. In total, 1565 patients were included in the study. Gender

did not influence treatment response. Consistently, concomitant

methotrexate (MTX) was significantly associated with EULAR remission,

EULAR good response, ACR50 response and ACR70 response with odds

ratios (ORs) 1.97, 2.13, 2.10 and 1.75, respectively. Concurrent

treatment with other DMARDs was also significantly associated with

EULAR remission, EULAR good response and ACR50 response (OR: 1.96,

2.24 and 1.94, respectively). Likewise, low HAQ at baseline

consistently predicted good clinical outcome. Disease activity at

baseline was directly associated with favourable response when

measured by ACR50 and ACR70 (OR: 1.59 and 1.60, respectively), whereas

DAS28 score at baseline was inversely associated with EULAR remission

(OR: 0.78).

Conclusion. In this observational study of patients with established

RA, gender did not predict response to anti-TNF therapy, whereas

treatment with concomitant DMARDs, especially MTX and low disability

were associated with good response. Choice of outcome measures may

influence the predictive value of baseline features.

http://rheumatology.oxfordjournals.org/cgi/content/abstract/ken002v1?papetoc

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