OP0232 Female gender and positive rheumatoid factor predict low serum infliximab levels and positive anti-drug antibodies, which associate with treatment failure on infliximab in patients with early rheumatoid arthritis. report from the swefot trial population
Authors: K. Hambardzumyan, C. Hermanrud, P. Marits, N. Vivar, S. Ernestam, J.K. Wallman, R.F. van Vollenhoven, A. Fogdell-Hahn, S. Saevarsdottir
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Tumour necrosis factor (TNF) inhibitors, with infliximab (IFX) first on the market, have revolutionised treatment of patients with rheumatoid arthritis (RA). However, in a substantial proportion of patients, they lose efficiency, and up to 44% of patients have been found to develop anti-drug antibodies (ADA), leading to low serum IFX (sIFX) levels. Despite this, sIFX measurement is still rarely used for clinical decision making, and standardised clinical threshold titre levels have not been clearly defined. <h3>Objectives</h3> In an early RA trial adding IFX to methotrexate (MTX) in patients not achieving low disease activity (LDA=DAS28≤3.2) after 3 months monotherapy, we studied whether sIFX or ADA were associated with treatment outcome, and whether easily available baseline parameters predicted ADA development. <h3>Methods</h3> Of IFX-treated SWEFOT patients (n=128), 101 had available serum samples at follow-up, which were analysed for sIFX levels at 3, 9 and 21 months (routine ELISA). Samples with undetectable sIFX (&lt;0.2 µg/ml) were analysed further for ADA using direct ELISA with plate-bound TNF. Primary and secondary outcome measures were LDA and remission (DAS28 &lt;2.6) at 21 months. Clinical and demographic characteristics of patients at start of IFX therapy (baseline) were tested as potential predictors of ADA development, using uni- and multivariate logistic regression. <h3>Results</h3> At 3, 9 and 21 months from IFX add-on to MTX, 15%, 23% and 28% of patients, respectively, had undetectable sIFX, and 34% were ever ADA-positive. Significantly higher proportion of patients achieved LDA among those with detectable sIFX, versus undetectable sIFX and positive ADA (67% vs 26%, p=0.002, figure 1A), with similar difference for remission (47% vs 11%, p=0.004, figure 1B). When sIFX levels were further stratified into &lt;0.2, 0.2–5.0, 5.0–10.0 and &gt;10 µg/ml, there was a significant trend across the groups in achievement of LDA (30%, 65%, 70% and 83% respectively, p=0.008, figure 1C) or remission (10%; 41%, 52% and 67%, respectively, p=0.004, figure 1D). Women had undetectable sIFX at 21 months more often than men (35% vs 7%, p=0.006). In multivariate logistic regression analysis, the following baseline characteristics were significant predictors of ever ADA-positivity: female gender, RF-positivity, higher tender joint count, erythrocyte sedimentation rate and lower health assessment questionnaire score (data not shown). <h3>Conclusions</h3> In early RA patients receiving add-on IFX therapy, ADA-positivity or lower serum IFX levels were associated with a higher risk of not reaching treatment targets, that is LDA or remission. RF positivity and female gender, factors known to be associated with worse clinical outcomes, predicted development of ADA. <h3>Disclosure of Interest</h3> K. Hambardzumyan: None declared, C. Hermanrud: None declared, P. Marits: None declared, N. Vivar: None declared, S. Ernestam: None declared, J. Wallman Consultant for: AbbVie, Celgene, Eli Lilly, Novartis, UCB, R. van Vollenhoven Grant/research support from: AbbVie, BMS, GSK, Pfizer, UCB, Consultant for: AbbVie, AstraZeneca, Biotest, BMS, Celgene, GSK, Janssen, Lilly, Novartis, Pfizer, UCB, A. Fogdell-Hahn Grant/research support from: Pfizer, S. Saevarsdottir: None declared