The Clinical Impact of Seropositivity on Treatment Response in Patients with Rheumatoid Arthritis Treated with Etanercept: A Real-World Iraqi Experience

Abstract

Asal Ridha,1 Saba Hussein,2 Ali AlJabban,3 Levent Mert Gunay,3 Faiq I Gorial,4 Nizar Abdulateef Al Ani4 1Rheumatology Unit, Department of Medicine, Baghdad Teaching Hospital, Medical City, Baghdad, Iraq; 2Rheumatology Unit, Department of Medicine, Al-Kindy Teaching Hospital, Baghdad, Iraq; 3Medical Department, Pfizer, Baghdad, Iraq; 4Rheumatology Unit, Department of Medicine, College of Medicine, University of Baghdad, Baghdad, IraqCorrespondence: Ali AlJabban, Medical Department, Pfizer, Building 5, Street 51, Sec. 611, AlDawoodi, Baghdad, Iraq, Tel [phone], Email [email protected]: To assess the clinical impact of rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibody (ACPA)’s seropositivity on treatment response in patients with rheumatoid arthritis (RA) treated with etanercept.Patients and Methods: A retrospective analysis of patients with RA registered in Baghdad Teaching Hospital Registry from May 2012 to August 2019 was conducted. Patients aged ≥ 18 years, meeting the ACR/EULAR 2010 criteria for RA, being treated with etanercept, and followed up at ≥ 1 year after etanercept initiation were included; patients who received any other biologics for RA were excluded. Patients were classified as seropositive (RF- and ACPA-positive), seronegative (RF- and ACPA-negative), RF-positive, RF-negative, ACPA-positive, and ACPA-negative. The primary outcomes included Clinical Disease Activity Index (CDAI) and Disease Activity Score 28 (DAS28) which were measured at one year after treatment initiation.Results: At baseline, a total of 1318 (88.3%) patients were seropositive; 1122 (75.2%) and 1054 (70.6%) patients were RF- and ACPA-positive, respectively. Baseline mean CDAI scores were significantly (P = 0.001) higher among seropositive patients compared with seronegative patients. The baseline mean DAS28 score was also significantly higher in ACPA-positive group compared with the ACPA-negative group (P = 0.021). At baseline, the number of patients who had high CDAI scores was significantly higher among the seropositive, RF-positive, and ACPA-positive groups (P = 0.001, P = 0.001, and P = 0.002, respectively). After one year of treatment with etanercept, among seropositive versus seronegative and ACPA-positive versus ACPA-negative groups, there was a significant improvement in terms of the mean CDAI score (P = 0.004 and P = 0.017, respectively) and CDAI response (P = 0.011 and P = 0.048, respectively). At one year, the proportion of patients among the seropositive versus seronegative group who reached remission were 566 (42.9%) versus 78 (44.6%) and 642 (47.3%) versus 83 (47.4%), for CDAI and DAS28 response, respectively.Conclusion: The results imply that seropositivity and ACPA-positivity may influence the treatment response in patients with RA, who were treated with etanercept.Keywords: anti-cyclic citrullinated peptide antibody, Iraq, real-world, rheumatoid factor

Keywords

• anti-cyclic citrullinated peptide antibody
• iraq
• real-world
• rheumatoid factor