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. 2024 Sep 4:11:1461396.
doi: 10.3389/fmed.2024.1461396. eCollection 2024.

Influence of rheumatoid factor levels and TNF inhibitor structure on secondary nonresponse in rheumatoid arthritis patients

Chamaida Plasencia-Rodríguez #  1   2 , Ana Martínez-Feito #  2   3 , Marta Novella-Navarro  1   2 , Rebeca Pérez De Diego  4   5   6 , Gema Bonilla  1   2 , Johanna Elin Gehin  7 , Alejandro Villalba-Yllán  1 , Laura Nuño  1 , Dora Pascual-Salcedo  2 , Pilar Nozal  3   8 , Mariana Díaz Almirón  9 , Alejandro Balsa  1   2
Affiliations

Influence of rheumatoid factor levels and TNF inhibitor structure on secondary nonresponse in rheumatoid arthritis patients

Chamaida Plasencia-Rodríguez et al. Front Med (Lausanne). .

Abstract

Background: The EXXELERATE study revealed poorer clinical outcomes in patients treated with adalimumab (ADL) and baseline rheumatoid factor (RF) above 203 IU/mL. However, responses were similar in patients treated with certolizumab pegol (CZP) regardless of RF levels.

Objectives: This study investigated the impact of RF levels >203 IU/mL on TNF inhibitors (TNFi) serum levels and the association with secondary nonresponse in RA patients treated with TNFi.

Methods: We performed an observational ambispective study with RA patients treated with infliximab (IFX), ADL, or CZP. Patients were stratified according to baseline RF levels: ≤ or >203 IU/mL. After 6 months, serum drug levels and antidrug antibodies were measured, and reasons for discontinuation were collected.

Results: We included 170 RA patients: 90 (53%) received IFX, 48 (28%) ADL, and 32 (19%) CZP. While CZP serum levels did not differ between RF groups at 6 months (p = 0.6), RF levels >203 IU/mL were linked to lower serum drug levels in patients treated with IFX (p = 0.09) or ADL (p = 0.02). Secondary nonresponse was 3.6 times higher in patients with high versus low RF levels in patients under IFX or ADL. However, the reasons for withdrawal were not affected by RF levels in patients treated with CZP.

Conclusion: Baseline RF above 203 IU/mL is associated with lower serum drug levels and an increased risk of discontinuation due to secondary nonresponse in patients treated with IFX or ADL. In contrast, drug levels and clinical outcomes are not significantly impacted by baseline RF levels in patients under CZP.

Keywords: TNF inhibitors; adalimumab; certolizumab pegol; infliximab; monoclonal antibodies; rheumatoid arthritis; rheumatoid factor.

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Conflict of interest statement

CP-R has received research grants/honoraria from AbbVie, Pfizer, Novartis, Lilly, and Roche. MN-N has received research grants/honoraria from Galápagos, Janssen, Lilly, Novartis, and UCB. AB received grant/research support and fees for consultancies or as a speaker from AbbVie, Amgen, Pfizer, Novartis, BMS, Nordic, Sanofi, Sandoz, Lilly, UCB, and Roche. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Cumulative incidence of dropout due to secondary nonresponse according to baseline RF levels. (A) In the MAB group (n = 138). (B) In the PEG group (n = 32).
See this image and copyright information in PMC

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