Correlation of antinuclear antibody and anti-double-stranded DNA antibody with clinical response to infliximab in patients with rheumatoid arthritis: a retrospective clinical study

Abstract

IntroductionThe induction of antinuclear antibodies (ANAs) or anti-double-stranded (ds) -DNA antibodies (Abs) after infliximab (IFX) therapy in rheumatoid arthritis (RA) is a well-known phenomenon, but the correlation of such Abs with the clinical response to IFX has not yet been determined. The aims of this retrospective observational study were to examine the prevalence of positive ANA and anti-ds-DNA Abs before and after IFX therapy in patients with RA and to investigate whether an increased titer of such Abs is associated with the clinical efficacy of IFX.MethodsOne hundred eleven RA patients who had received IFX were studied. ANA (indirect immunofluorescence with HEp-2 cells) and anti-ds-DNA Abs (Farr assay) results were examined before and after IFX therapy.ResultsThe overall clinical response assessed by EULAR response criteria was as follows: good response in 55%, including remission in 38%; moderate response in 18%; and no response (NOR) in 27%. The positivity of ANA (≥ 1:160) and anti-ds-DNA Abs significantly increased from 25% to 40% (P = 0.03) and from 3% to 26% (P < 0.001) after IFX, respectively. EULAR response differed significantly according to the ANA titer before IFX (P = 0.001), and the efficacy of IFX became worse as the ANA titer before starting IFX increased. Furthermore, the differences in the clinical response of the ANA titer before IFX ≤ 1:80 and ≥ 1:160 were significant (good, moderate, and no response were 66%, 9%, and 25% in ≤ 1:80 group versus 26%, 33%, 41% in ≥ 1:160 group, respectively; P < 0.001). In 13 patients whose ANA had increased after IFX, 10 showed NOR, only one showed a good response, and none reached remission. These clinical responses were significantly different from ANA no-change patients. In 21 patients with positive anti-ds-DNA Abs after IFX, 16 showed NOR, only two showed a good response, and none reached remission.ConclusionsThe present study suggests that the ANA titer before starting IFX predicts the clinical response to IFX. The increased titers of ANA or anti-ds-DNA Abs after IFX may be useful markers of NOR.

What is the utility of routine ANA testing in predicting development of biological DMARD-induced lupus and vasculitis in patients with rheumatoid arthritis? Data from a single-centre cohort

“…Correlation of ANA/anti-dsDNA antibodies with clinical response to infliximab in patients with RA has been reported previously but in a smaller cohort20 in which ANA appearance seemed to predict late cessation of treatment. Insufficient time for primary non-responders to develop ANA may be relevant, although we detected ANA as early as 4 weeks.…”

Antinuclear antibodies: two-step detection strategy

“…The development of ANA on HEp-2 cells after treatment with anti-TNF-a in both patients under infliximab treatment confirms previously published findings reporting this phenomenon (Arends et al, 2010;Hoxcha et al, 2006;Novak et al, 2011;Puertas-Abreu et al, 2012;Yukawa et al, 2011). The lack of reactivity in CLIA may be explained by the findings of Caramaschi et al (2007), who also obtained negative ANA results by ELISA and multiplexed fluorescent microsphere immunoassay.…”

Biologic and oral disease-modifying antirheumatic drug monotherapy in rheumatoid arthritis

“…Increased autoantibody formation correlates with lack of response to infliximab,37 suggesting immunologic abnormalities influence efficacy. Addition of an immunosuppressant, such as MTX, may reduce the risk of autoantibody development 36.…”