Rheumatology

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Predicting the future of anti-TNF therapy
Arthritis Research & Therapy, 07/01/09

Verweij CL – In the current issue of Arthritis Research & Therapy, Hueber and colleagues report that patients with features of an activated immune status in the peripheral blood compartment are more likely to benefit from anti-TNF treatment. Similar findings were reported for baseline synovial tissue markers associated with responsiveness.

• A multistep proteomics approach to identify a serum protein biomarker set that has predictive value prior to the start of etanercept treatment in RA pts
• Study is based on the premise of a role for differential autoantibody specificities and serum cytokine levels in guiding anti-TNF therapy
• Therapy responsiveness assessed 3 mo after the start of therapy, based on the ACR criteria
• An integrated analysis of a relevant set of 14 autoantibody specificities and a multiplex 12-cytokine Luminex data set

• 93 samples consisting of 3 independent cohorts:
  • A US based Autoimmune Biomarkers Collaborative Network (ABCoN) cohort; n=29
  • A Swedish cohort (n=43), and
  • A Japanese cohort (n=21)
    showed superior differentiation of responders and non-responders
• Autoantibodies were elevated and the trends for all analyzed cytokines, such as TNF, IL-15, MCP-1, and IL-6, revealed higher baseline serum concns in responders
• Subsequent prediction analysis on the full sample set was applied to select an integrated biomarker signature comprising 13 autoantibody specificities and 11 cytokines
• Although the overall prediction does not appear to be that strong, further optimization and preselection of pts on the basis of uniform DMARDs treatment regimens are likely to yield stronger predictive values

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