Clinical and Immunological Characteristics of Patients with Rheumatoid Arthritis on Synthetic DMARDS Therapy
Keywords:
Rheumatoid arthritis, adalimumab, methotrexate, observational study, disease activity, interleukin-6, interleukin-17.Abstract
This observational cohort study evaluated the efficacy and safety of different combinations of adalimumab and methotrexate in patients with rheumatoid arthritis (RA) who had an inadequate response to methotrexate monotherapy. The study population was divided into three groups based on their treatment regimen: Group IA (adalimumab 40 mg bi-weekly + methotrexate 7.5 mg weekly), Group IB (adalimumab 40 mg biweekly + methotrexate 15 mg weekly), and a comparison group (methotrexate 15 mg weekly). The primary outcome was the change in the Disease Activity Score based on 28 joints (DAS28) from baseline to 6 months. Secondary outcomes included the American College of Rheumatology (ACR) 20, 50, and 70 responses, changes in the Health Assessment Questionnaire-Disability Index (HAQ-DI) scores, and radiographic progression assessed using the modified Sharp/van der Heijde score (mTSS). Results demonstrated comparable baseline characteristics across groups, with no significant differences in age, gender distribution, disease duration, tender and swollen joint counts, and inflammatory markers. The analysis of immunological indexes, specifically interleukin-6 (IL-6) and interleukin-17 (IL-17), showed a correlation between their levels and disease severity as measured by the DAS28. Elevated levels of IL-6 and IL-17 were observed in patients with higher DAS28 scores, highlighting their role as biomarkers for assessing and monitoring RA disease activity. The study provides valuable insights into the comparative effectiveness of different treatment regimens and underscores the importance of personalized treatment strategies for RA patients.
References
Akram, M. S., Pery, N., Butler, L., Shafiq, M. I., Batool, N., Rehman, M. F. U., Grahame-Dunn, L. G., & Yetisen, A. K. (2021). Challenges for biosimilars: Focus on rheumatoid arthritis. Critical Reviews in Biotechnology, 41(1), 121–153. https://doi.org/10.1080/07388551.2020.1830746
Aletaha, D., & Smolen, J. S. (2018). Diagnosis and management of rheumatoid arthritis: A review. Jama, 320(13), 1360–1372.
Anderson, K. O., Bradley, L. A., Young, L. D., McDaniel, L. K., & Wise, C. M. (1985). Rheumatoid arthritis: Review of psychological factors related to etiology, effects, and treatment. Psychological Bulletin, 98(2), 358.
Bang, L. M., & Keating, G. M. (2004). Adalimumab: A Review of its Use in Rheumatoid Arthritis. BioDrugs, 18(2), 121–139. https://doi.org/10.2165/00063030-200418020-00005
Bartelds, G. M., Wijbrandts, C. A., Nurmohamed, M. T., Stapel, S., Lems, W. F., Aarden, L., Dijkmans, B. A., Tak, P. P., & Wolbink, G. J. (2007). Clinical response to adalimumab: Relationship to anti-adalimumab antibodies and serum adalimumab concentrations in rheumatoid arthritis. Annals of the Rheumatic Diseases, 66(7), 921–926.
Buchs, N. d, Di Giovine, F. S., Silvestri, T., Vannier, E., Duff, G. W., & Miossec, P. (2001). IL-1B and IL-1Ra gene polymorphisms and disease severity in rheumatoid arthritis: Interaction with their plasma levels. Genes & Immunity, 2(4), 222–228.
Firestein, G. S. (2003). Evolving concepts of rheumatoid arthritis. Nature, 423(6937), 356–361.
Kim, G. W., Lee, N. R., Pi, R. H., Lim, Y. S., Lee, Y. M., Lee, J. M., Jeong, H. S., & Chung, S. H. (2015). IL-6 inhibitors for treatment of rheumatoid arthritis: Past, present, and future. Archives of Pharmacal Research, 38, 575–584.
Narazaki, M., Tanaka, T., & Kishimoto, T. (2017). The role and therapeutic targeting of IL-6 in rheumatoid arthritis. Expert Review of Clinical Immunology, 13(6), 535–551. https://doi.org/10.1080/1744666X.2017.1295850
Ogata, A., Kato, Y., Higa, S., & Yoshizaki, K. (2019). IL-6 inhibitor for the treatment of rheumatoid arthritis: A comprehensive review. Modern Rheumatology, 29(2), 258–267.
Pickens, S. R., Volin, M. V., Mandelin, A. M., Kolls, J. K., Pope, R. M., & Shahrara, S. (2010). IL-17 contributes to angiogenesis in rheumatoid arthritis. The Journal of Immunology, 184(6), 3233–3241.
Radu, A.-F., & Bungau, S. G. (2021). Management of rheumatoid arthritis: An overview. Cells, 10(11), 2857.
Rajaei, E., Mowla, K., Hayati, Q., Ghorbani, A., Dargahi-Malamir, M., Hesam, S., & Zayeri, Z. D. (2020). Evaluating the relationship between serum level of interleukin-6 and rheumatoid arthritis severity and disease activity. Current Rheumatology Reviews, 16(3), 249–255.
Smolen, J. S., & Aletaha, D. (2015). Rheumatoid arthritis therapy reappraisal: Strategies, opportunities and challenges. Nature Reviews Rheumatology, 11(5), 276–289.
Van Den Berg, W. B., & Miossec, P. (2009). IL-17 as a future therapeutic target for rheumatoid arthritis. Nature Reviews Rheumatology, 5(10), 549–553.
Ravshanova, M. S., & Ibragimov, K. I. (2022, September). EFFECTIVENESS OF TRANSVAGINAL ULTRASOUND IN DIAGNOSIS OF ECTOPIC PREGNANCY. In INTERNATIONAL SCIENTIFIC CONFERENCE" INNOVATIVE TRENDS IN SCIENCE, PRACTICE AND EDUCATION" (Vol. 1, No. 2, pp. 114-115).
Ziolkowska, M., Koc, A., Luszczykiewicz, G., Ksiezopolska-Pietrzak, K., Klimczak, E., Chwalinska-Sadowska, H., & Maslinski, W. (2000). High levels of IL-17 in rheumatoid arthritis patients: IL-15 triggers in vitro IL-17 production via cyclosporin A-sensitive mechanism. The Journal of Immunology, 164(5), 2832–2838.
