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Observational Study
. 2015 Aug 7;17(1):200.
doi: 10.1186/s13075-015-0723-1.

MRP8/14 serum levels as a predictor of response to starting and stopping anti-TNF treatment in juvenile idiopathic arthritis

Janneke Anink  1 , Lisette W A Van Suijlekom-Smit  2 , Marieke H Otten  3 , Femke H M Prince  4 , Marion A J van Rossum  5 , Koert M Dolman  6 , Esther P A H Hoppenreijs  7 , Rebecca ten Cate  8 , Simona Ursu  9 , Lucy R Wedderburn  10 , Gerd Horneff  11 , Michael Frosch  12 , Thomas Vogl  13 , Faekah Gohar  14 , Dirk Foell  15 , Johannes Roth  16 , Dirk Holzinger  17
Affiliations
Observational Study

MRP8/14 serum levels as a predictor of response to starting and stopping anti-TNF treatment in juvenile idiopathic arthritis

Janneke Anink et al. Arthritis Res Ther. .

Abstract

Introduction: Approximately 30% of juvenile idiopathic arthritis (JIA) patients fail to respond to anti-TNF treatment. When clinical remission is induced, some patients relapse after treatment has been stopped. We tested the predictive value of MRP8/14 serum levels to identify responders to treatment and relapse after discontinuation of therapy.

Methods: Samples from 88 non-systemic JIA patients who started and 26 patients who discontinued TNF-blockers were analyzed. MRP8/14 serum levels were measured by in-house MRP8/14 ELISA and by Bühlmann Calprotectin ELISA at start of anti-TNF treatment, within 6 months after start and at discontinuation of etanercept in clinical remission. Patients were categorized into responders (ACRpedi ≥ 50 and/or inactive disease) and non-responders (ACRpedi < 50) within six months after start, response was evaluated by change in JADAS-10. Disease activity was assessed within six months after discontinuation.

Results: Baseline MRP8/14 levels were higher in responders (median MRP8/14 of 1466 ng/ml (IQR 1045-3170)) compared to non-responders (median MRP8/14 of 812 (IQR 570-1178), p < 0.001). Levels decreased after start of treatment only in responders (p < 0.001). Change in JADAS-10 was correlated with baseline MRP8/14 levels (Spearman's rho 0.361, p = 0.001). Patients who flared within 6 months after treatment discontinuation had higher MRP8/14 levels (p = 0.031, median 1025 ng/ml (IQR 588-1288)) compared to patients with stable remission (505 ng/ml (IQR 346-778)). Results were confirmed by Bühlmann ELISA with high reproducibility but different overall levels.

Conclusion: High levels of baseline MRP8/14 are associated with good response to anti-TNF treatment, whereas elevated MRP8/14 levels at discontinuation of etanercept are associated with higher chance to flare.

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Figures

Fig. 1
Fig. 1
Differences in myeloid related protein (MRP)8/14 serum levels between non-responders and responders before starting treatment
Fig. 2
Fig. 2
a Change in myeloid related protein (MRP)8/14 serum levels in non-responders pre-treatment compared to levels after treatment for an average of 3.2 months. b Change in MRP8/14 serum levels in responders pre-treatment compared to levels after treatment for an average of 3.2 months
Fig. 3
Fig. 3
Differences in myeloid related protein (MRP)8/14 at time of medication discontinuation between patients who then had persistent remission and patients who had flares
See this image and copyright information in PMC

References

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