Mihajloska Evgenija, Dimkovski Aleksandar, Grozdanova Aleksandra, Vasilevska Ana, Antova Dubravka, Naumovska Zorica, Nestorovska Aleksandra Kapedanovska, Sterjev Zoran, Osmani Bashkim, Shuturkova Ljubica
Faculty of Pharmacy, Ss. Cyril and Methodius University in Skopje, R.N. Macedonia.
University Clinic of Rheumatology, Skopje, R.N. Macedonia.
Reumatologia. 2024;62(3):150-156. doi: 10.5114/reum/189780. Epub 2024 Jun 18.
Identifying early predictive factors of how rheumatoid arthritis (RA) patients respond to rituximab (RTX) treatment is crucial for both individual treatment outcome and the improvement of clinical practice overall. This study aimed to identify early predictive factors available in standard clinical practice for predicting RTX treatment outcomes in RA patients.
Data on seventy patients diagnosed with RA treated with RTX (two 1,000 mg doses 2 weeks apart or two 500 mg doses 2 weeks apart) were retrospectively collected. Baseline information collected at the initiation of RTX treatment included patient characteristics such as age, sex, disease duration, disease activity, Health Assessment Questionnaire score, erythrocyte sedimentation rate, C-reactive protein, and serological status regarding rheumatoid factor (RF) and anti-cyclic citrullinated protein antibodies (ACPA). Clinical responses were analyzed 6 months after RTX initiation using the European Alliance of Associations for Rheumatology criteria. Potential predictors associated with positive RTX response at 6 months were identified using a multivariate ordinal logistic regression model.
The analysis showed that persistently active RA disease, Disease Activity Score with 28-joint count (DAS28) values at the treatment onset and after 3 months, along with erythrocyte sedimentation rate at treatment initiation, were negatively correlated with the response to RTX therapy ( < 0.05). All these correlations were statistically significant at the 99% confidence interval. The correlation and logistic regression analyses indicate that there are no significant association between RF and ACPA concerning therapy response, despite a higher number of RTX responders in the seropositive groups. Additionally, the study emphasizes the prognostic significance of the DAS28 value at treatment initiation in predicting therapy response at 6 months.
The optimal model for predicting RTX response at 6 months involves the interaction of all clinical factors examined in this study, as revealed by the analysis of multiple variables.
识别类风湿关节炎（RA）患者对利妥昔单抗（RTX）治疗反应的早期预测因素，对于个体治疗结果以及整体临床实践的改善都至关重要。本研究旨在确定标准临床实践中可用于预测RA患者RTX治疗结果的早期预测因素。
回顾性收集了70例接受RTX治疗的RA患者的数据（相隔2周给予两剂1000mg或相隔2周给予两剂500mg）。RTX治疗开始时收集的基线信息包括患者特征，如年龄、性别、病程、疾病活动度、健康评估问卷评分、红细胞沉降率、C反应蛋白以及类风湿因子（RF）和抗环瓜氨酸肽抗体（ACPA）的血清学状态。在RTX开始治疗6个月后，使用欧洲风湿病协会联盟标准分析临床反应。使用多变量有序逻辑回归模型确定与6个月时RTX阳性反应相关的潜在预测因素。
分析表明，持续活动的RA疾病、治疗开始时和3个月后的28关节计数疾病活动评分（DAS28）值以及治疗开始时的红细胞沉降率与RTX治疗反应呈负相关（<0.05）。所有这些相关性在99%置信区间均具有统计学意义。相关性和逻辑回归分析表明，尽管血清阳性组中RTX反应者数量较多，但RF和ACPA与治疗反应之间无显著关联。此外，该研究强调了治疗开始时DAS28值在预测6个月时治疗反应方面的预后意义。
多变量分析显示，预测6个月时RTX反应的最佳模型涉及本研究中检查的所有临床因素的相互作用。
