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Rodríguez-Martín, Eulalia; Nieto-Gañán, Israel; Hernández-Breijo, Borja; Sobrino, Cristina; García-Hoz, Carlota; Bachiller, Javier; Martínez-Feito, Ana; Navarro-Compán, Victoria; Lapuente-Suanzes, Paloma; Bonilla, Gema; Pascual-Salcedo, Dora; Roy, Garbiñe; Jurado, Teresa; Nozal, Pilar; Vázquez-Díaz, Mónica; Balsa, Alejandro; Villar, Luisa M; Plasencia-Rodríguez, Chamaida
Frontiers in immunology, 08/2020, Volume: 11Journal Article
TNF inhibitors (TNFis) are widely used for the treatment of rheumatoid arthritis (RA), although the response rates to this therapy in patients with RA remains heterogeneous and < 50% achieve remission (REM). To analyze baseline peripheral blood leukocytes profiles in order to search for biomarkers identifying patients who will most likely not achieve REM under TNFi treatment. A prospective bi-center pilot study including 98 RA patients treated with TNFis and followed-up during 6 months. Patients were classified according to DAS28 as follows: those who achieved REM (DAS28 ≤ 2.6) and those who did not (DAS28 > 2.6) at 6 months after starting TNFis. These rates were also assessed by simplified disease activity index (SDAI ≤ 3.3 and SDAI > 3.3, respectively). Peripheral blood immune cells were studied by flow cytometry before treatment initiation. At 6 months, 61 or 80% of patients did not achieve REM by DAS28 or SDAI, respectively. Basal leukocyte profiles differed between REM vs. non-REM patients. Non-REM patients showed lower percentages of total and naïve B cells at baseline than REM subjects. A B lymphocyte/CD4+ lymphocyte ratio (BL/CD4 ratio) <0.2 clearly associated with a higher probability of non-REM status based on DAS28 at 6 months (OR = 9.2, = 0.006). These data were confirmed when patient response was evaluated by SDAI index. Our results strongly suggest that BL/CD4 ratio could be considered as a useful biomarker for the early identification of non-remitters to TNFi in clinical practice.
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