Rheumatoid factor titers, but not Fc fragments, may be strongly associated with drug survival of anti-TNF agents in patients with rheumatoid arthritis

OBJECTIVE: To investigate the effects of both the Fc fragment in tumor necrosis factor (TNF) inhibitors and rheumatoid
factor (RF) titers on treatment survival, disease activity, and laboratory parameters in patients with rheumatoid arthritis (RA).
METHODS: In this retrospective cohort study, patients with RA who had started any anti-TNF therapy between January 2017 and March 2020 and who had stayed on this treatment for at least six months were included. The data of the patients were compared separately according to continuation or discontinuation of treatment and the presence or absence of Fc portion in the structure of anti-TNFs. Patients who were taking certolizumab pegol (CZP) without the Fc fragment were placed in the “without Fc group” (wo/Fc), while patients who were taking other drugs (adalimumab, etanercept, golimumab, and infliximab) were placed in the “with Fc group” (w/Fc).
RESULTS: Among the 221 RA patients whose data were available, 52 patients met the inclusion criteria and were included in the study. There was a significant difference in the DAS28-CRP score between wo/Fc group and w/Fc group in the third month of treatment (p=0.012). However, this difference did not persist at the sixth month of treatment (p=0.384). According to the cox-regression results, RF titers were determined to have a significant impact on the drug survival of anti-TNF agents when adjustments were made for the effects of other candidate predictors (Hazard ratio: 1.007 (1.002–1.012), p=0.009).
CONCLUSION: Our results suggest that compared to the Fc fragment, RF titers were the more important risk factor in survival of anti-TNF drugs.

Romatoid artritli hastalarda anti-TNF ajanlarýn ilaç saðkalýmý ile Fc fragmanlarý deðil romatoid faktör titreleri güçlü bir þekilde iliþkili olabilir

Amaç: Hem tümör nekroz faktörü (TNF) inhibitörlerindeki Fc fragmanýnýn hem de romatoid faktör (RF) titrelerinin romatoid artritli (RA) hastalarda tedavi saðkalýmý, hastalýk aktivitesi ve laboratuvar parametreleri üzerindeki etkilerini araþtýrmaktýr.
Yöntem: Bu retrospektif kohort çalýþmasýna Ocak 2017 ile Mart 2020 arasýnda herhangi bir anti-TNF tedavi baþlanan ve bu tedaviyi en az altý ay süreyle sürdüren RA'lý hastalar dahil edildi. Hastalarýn verileri tedaviye devam edip etmeme ve anti-TNF'lerin yapýsýnda Fc kýsmýnýn bulunup bulunmamasýna göre ayrý ayrý karþýlaþtýrýldý. Fc fragmaný olmayan sertolizumab pegol (CZP) kullanan hastalar “Fc içermeyen grup” (wo/Fc), diðer ilaçlarý kullanan hastalar (adalimumab, etanercept, golimumab, and infliksimab) “Fc içeren grup” (w/Fc) olarak belirlendi.
Bulgular: Verileri mevcut olan 221 RA hastasýndan 52’si dahil edilme kriterlerini karþýladý ve çalýþmaya alýndý. Tedavinin üçüncü ayýnda wo/Fc grubu ile w/Fc grubu arasýnda DAS28-CRP skorunda anlamlý fark vardý (p=0.012). Ancak bu fark tedavinin altýncý ayýnda devam etmedi (p=0.384). Cox-regresyon sonuçlarýna göre diðer aday prediktörlerin etkileri için düzeltmeler yapýldýðýnda RF titrelerinin anti-TNF ajanlarýn ilaç saðkalýmý üzerinde önemli bir etkiye sahip olduðu belirlendi (Hazard ratio: 1.007 (1.002–1.012), p=0.009).
Sonuç: Sonuçlarýmýz Fc fragmanýyla karþýlaþtýrýldýðýnda RF titrelerinin anti-TNF ilaçlarýn saðkalýmýnda daha önemli risk faktörü olduðunu göstermektedir. (NCI-2023-3-3)