Photo Credit: Suze777

The following is a summary of “Impact of autoantibodies on the efficacy of biological disease-modifying anti-rheumatic drugs in rheumatoid arthritis: meta-analysis of randomized controlled trials,” published in the February 2024 issue of Rheumatology by Takase-Minegishi et al.

Researchers conducted a retrospective study to assess the effectiveness of biologic disease-modifying anti-rheumatic drugs (bDMARDs) in rheumatoid arthritis (RA) patients with rheumatoid factor (RF) or anti-citrullinated protein antibodies (ACPA) in comparison to those without these autoantibodies.

They searched for previous systematic literature reviews conducted by EULAR RA management task forces to identify relevant RCTs. Eligible RCTs examined the efficacy of bDMARDs and included both antibodies positive (≤80% of total population) and negative RA patients. For trials comparing bDMARD+csDMARD vs csDMARD alone, they calculated relative risks (RR) for efficacy outcomes in each group (RF + vs RF-, ACPA+ vs ACPA-). The Computed relative risk ratios (RRRs) as the ratio of RR from the bDMARD-arm to RR from the non-bDMARD-arm. Pooled effects were obtained through random-effect meta-analyses.

The results showed that in the analysis of data from 28 eligible RCTs, pooling 23 studies into three subgroups, including 6 with csDMARD-naïve patients, 14 with csDMARD-IR patients, and 3 with TNFi-IR patients, seropositivity was not linked to a superior response to bDMARDs in csDMARD-naïve and csDMARD-IR patients, with pooled 6-month ACR20 RRRs of 1.02 (0.88–1.18) and 1.09 (0.90–1.32. Other outcomes did not display any disparity between the groups. In TNFi-IR patients, based on 3 trials, the 6-month ACR20 RRR was 2.28 (1.31–3.95), indicating a favorable efficacy in seropositive patients. Most other outcomes demonstrated no significant variance between the groups. Across TNFi and non-TNFi treatments and individual bDMARDs, efficacy remained comparable between RF-positive and RF-negative patients, regardless of the mode of action.

Investigators concluded that bDMARDs’ effectiveness in RA doesn’t differ based on the presence or absence of autoantibodies like RF/ACPA.

Source: academic.oup.com/rheumatology/advance-article-abstract/doi/10.1093/rheumatology/keae113/7609797