The following is a summary of “Effectiveness of biological targeted therapies may discriminate seronegative from seropositive rheumatoid arthritis,” published in the November 2023 issue of Rheumatology by Iannone et al.
Researchers conducted a retrospective study to evaluate the effectiveness of biological therapies in rheumatoid arthritis (RA) patients who are negative for rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPA).
They chose 81 seronegative and 404 seropositive RA patients treated with abatacept, anti-tumor necrosis factor (TNF) alpha, or tocilizumab. Effectiveness was assessed by examining drug survival through Kaplan–Meyer analysis during a 10-year follow-up. Log-rank tests compared survival rates, and multivariate Cox-regression estimated HRs for therapy discontinuation.
The results showed similar clinical characteristics between the 2 groups, except for a significantly higher percentage of inadequate responders to prior bDMARDs in seronegative RA patients (P=0.02). In seronegative RA, tocilizumab exhibited a survival rate of 73.9% with a mean survival time (MST) of 76.8 months (95% CI 61–92), significantly higher than abatacept (37.5%, MST 37.1 months, 95% CI 22–51; P=0.01). Anti-TNF alpha therapy showed intermediate effectiveness (50.0%, MST 63.5 months, 95% CI 47–79), with no significant difference observed in drug survival rates among seropositive RA patients. Negative predictors of drug discontinuation were RF/ACPA positivity (HR 0.56) and male sex (HR 0.58), while positive predictors included treatment with abatacept (HR 1.88) or anti-TNF alpha (HR 1.79), no co-therapy with cDMARD (HR 1.74), absence of bone erosions (HR 1.41), and higher HAQ (HR 1.58).
Investigators concluded that larger studies are needed to confirm findings and explore personalized treatment strategies for seronegative RA.
