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Predictors of response to TNF antagonists in patients with ankylosing spondylitis and psoriatic arthritis: systematic review and meta-analysis.

Maneiro JR, Souto A, Salgado E, Mera A, Gomez-Reino JJ - RMD Open (2015)

Bottom Line: Similar results were found for ASAS criteria response.No predictors of response were identified in PsA.Young age, male sex, high baseline BASDAI, low baseline BASFI, high baseline CRP and HLA-B27 predict better response to TNF antagonists in AS but not in PsA.

View Article: PubMed Central - PubMed

Affiliation: Rheumatology Unit , Complejo Hospitalario Universitario de Santiago de Compostela , Santiago , Spain.

ABSTRACT

Objective: To identify predictors of response to tumor necrosis factor (TNF) antagonists in ankylosing spondylitis (AS) and psoriatic arthritis (PsA).

Methods: Systematic review and meta-analysis of clinical trials and observational studies based on a systematic search. Meta-analyses of similar observations were performed using random effects computing summary OR. Heterogeneity was tested using I(2), and risks of bias using funnel plots and the Egger test. Meta-regression was used to explore causes of heterogeneity.

Results: The electronic search captured 1340 references and 217 abstracts. 17 additional articles were identified after searching by hand. A total of 59 articles meet the purpose of the study and were reviewed. 37 articles (33 studies) included 6736 patients with AS and 23 articles (22 studies) included 4034 patients with PsA. 1 article included data on AS and PsA. Age (OR (95% CI) 0.91 (0.84 to 0.99), I(2)=84.1%), gender (1.57 (1.10 to 2.25), I(2)=0.0%), baseline BASDAI (1.31 (1.09 to 1.57), I(2)=0.0%), baseline BASFI (0.86 (0.79 to 0.93), I(2)=24.9%), baseline dichotomous C reactive protein (CRP) (2.14 (1.71 to 2.68), I(2)=22.3%) and human leucocyte antigen B27 (HLA-B27) (1.81 (1.35 to 2.42), I(2)=0.0%) predict BASDAI50 response in AS. No factor was identified as a source of heterogeneity. Only meta-analysis of baseline BASFI showed risk of publication bias (Egger test, p=0.004). Similar results were found for ASAS criteria response. No predictors of response were identified in PsA.

Conclusions: Young age, male sex, high baseline BASDAI, low baseline BASFI, high baseline CRP and HLA-B27 predict better response to TNF antagonists in AS but not in PsA.

No MeSH data available.


Related in: MedlinePlus

Meta-analysis of C reactive protein (CRP) as predictor of response in ankylosing spondylitis (AS). (A) Meta-analysis of dichotomous CRP and ASAS20 in AS. (B) Meta-analysis of dichotomous CRP and ASAS40 in AS. (C) Meta-analysis of continuous CRP and BASDAI in AS. (D) Meta-analysis of dichotomous CRP and BASDAI50 in AS. NA: not available.
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RMDOPEN2014000017F3: Meta-analysis of C reactive protein (CRP) as predictor of response in ankylosing spondylitis (AS). (A) Meta-analysis of dichotomous CRP and ASAS20 in AS. (B) Meta-analysis of dichotomous CRP and ASAS40 in AS. (C) Meta-analysis of continuous CRP and BASDAI in AS. (D) Meta-analysis of dichotomous CRP and BASDAI50 in AS. NA: not available.

Mentions: Twenty four articles reported serological factors as predictors of response to TNF antagonists in AS.26–28303133–3537–394145–4749–52555658–60 Individual results showed better response in patients with high levels of C reactive protein (CRP) in 22 articles.2628303133343537394145–4749–52555658–60 Meta-analysis of CRP and ASAS20 in six articles showed an OR of 2.53 (2.00 to 3.21) with an I2 of 0.0% (figure 3A), and risk of publication bias (p=0.015).303133375859 Meta-analysis of CRP and ASAS40 in three articles showed an OR of 2.03 (1.49 to 2.76) with an I2 of 27.6% (figure 3B), and no risk of publication bias (p=0.563).333550 Meta-analysis of CRP and BASDAI50 in three articles,264651 and subgroups of another study52 showed an OR of 1.05 (1.01 to 1.08) with an I2 of 85.5% (figure 3C), and risk of publication bias (p=0.008). No factor was identified as a source of heterogeneity. Sensitivity analysis showed one study as a source of heterogeneity, and when this study was removed from the meta-analysis, the OR was of 1.02 (1.01 to 1.03) with an I2 of 0.0%.51 Meta-analysis of dichotomous CRP and BASDAI50 in six articles showed an OR of 2.14 (1.71 to 2.68) with an I2 of 22.4% (figure 3D), and no risk of publication bias (p=0.267).2833–355059 High levels of serum amyloid A presented an association with better response in one study.31 Erythrocyte sedimentation rate (ESR) showed contradictory results in two studies.2631 High levels of interleukin (IL)-6 at baseline were related with ASAS but not with BASDAI50 response.475960 Other biomarkers such as matrix metalloproteinase-3 (MMP-3), osteocalcin, insulin, leptin, tissue inhibitor of metalloproteinases 1, apolipoprotein CIII, IgM, N-terminal propeptide of type 1collagen (P1NP), deoxypyridinoline and vascular endothelial growth factor were not consistently associated with response.27475960


Predictors of response to TNF antagonists in patients with ankylosing spondylitis and psoriatic arthritis: systematic review and meta-analysis.

Maneiro JR, Souto A, Salgado E, Mera A, Gomez-Reino JJ - RMD Open (2015)

Meta-analysis of C reactive protein (CRP) as predictor of response in ankylosing spondylitis (AS). (A) Meta-analysis of dichotomous CRP and ASAS20 in AS. (B) Meta-analysis of dichotomous CRP and ASAS40 in AS. (C) Meta-analysis of continuous CRP and BASDAI in AS. (D) Meta-analysis of dichotomous CRP and BASDAI50 in AS. NA: not available.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4612701&req=5

RMDOPEN2014000017F3: Meta-analysis of C reactive protein (CRP) as predictor of response in ankylosing spondylitis (AS). (A) Meta-analysis of dichotomous CRP and ASAS20 in AS. (B) Meta-analysis of dichotomous CRP and ASAS40 in AS. (C) Meta-analysis of continuous CRP and BASDAI in AS. (D) Meta-analysis of dichotomous CRP and BASDAI50 in AS. NA: not available.
Mentions: Twenty four articles reported serological factors as predictors of response to TNF antagonists in AS.26–28303133–3537–394145–4749–52555658–60 Individual results showed better response in patients with high levels of C reactive protein (CRP) in 22 articles.2628303133343537394145–4749–52555658–60 Meta-analysis of CRP and ASAS20 in six articles showed an OR of 2.53 (2.00 to 3.21) with an I2 of 0.0% (figure 3A), and risk of publication bias (p=0.015).303133375859 Meta-analysis of CRP and ASAS40 in three articles showed an OR of 2.03 (1.49 to 2.76) with an I2 of 27.6% (figure 3B), and no risk of publication bias (p=0.563).333550 Meta-analysis of CRP and BASDAI50 in three articles,264651 and subgroups of another study52 showed an OR of 1.05 (1.01 to 1.08) with an I2 of 85.5% (figure 3C), and risk of publication bias (p=0.008). No factor was identified as a source of heterogeneity. Sensitivity analysis showed one study as a source of heterogeneity, and when this study was removed from the meta-analysis, the OR was of 1.02 (1.01 to 1.03) with an I2 of 0.0%.51 Meta-analysis of dichotomous CRP and BASDAI50 in six articles showed an OR of 2.14 (1.71 to 2.68) with an I2 of 22.4% (figure 3D), and no risk of publication bias (p=0.267).2833–355059 High levels of serum amyloid A presented an association with better response in one study.31 Erythrocyte sedimentation rate (ESR) showed contradictory results in two studies.2631 High levels of interleukin (IL)-6 at baseline were related with ASAS but not with BASDAI50 response.475960 Other biomarkers such as matrix metalloproteinase-3 (MMP-3), osteocalcin, insulin, leptin, tissue inhibitor of metalloproteinases 1, apolipoprotein CIII, IgM, N-terminal propeptide of type 1collagen (P1NP), deoxypyridinoline and vascular endothelial growth factor were not consistently associated with response.27475960

Bottom Line: Similar results were found for ASAS criteria response.No predictors of response were identified in PsA.Young age, male sex, high baseline BASDAI, low baseline BASFI, high baseline CRP and HLA-B27 predict better response to TNF antagonists in AS but not in PsA.

View Article: PubMed Central - PubMed

Affiliation: Rheumatology Unit , Complejo Hospitalario Universitario de Santiago de Compostela , Santiago , Spain.

ABSTRACT

Objective: To identify predictors of response to tumor necrosis factor (TNF) antagonists in ankylosing spondylitis (AS) and psoriatic arthritis (PsA).

Methods: Systematic review and meta-analysis of clinical trials and observational studies based on a systematic search. Meta-analyses of similar observations were performed using random effects computing summary OR. Heterogeneity was tested using I(2), and risks of bias using funnel plots and the Egger test. Meta-regression was used to explore causes of heterogeneity.

Results: The electronic search captured 1340 references and 217 abstracts. 17 additional articles were identified after searching by hand. A total of 59 articles meet the purpose of the study and were reviewed. 37 articles (33 studies) included 6736 patients with AS and 23 articles (22 studies) included 4034 patients with PsA. 1 article included data on AS and PsA. Age (OR (95% CI) 0.91 (0.84 to 0.99), I(2)=84.1%), gender (1.57 (1.10 to 2.25), I(2)=0.0%), baseline BASDAI (1.31 (1.09 to 1.57), I(2)=0.0%), baseline BASFI (0.86 (0.79 to 0.93), I(2)=24.9%), baseline dichotomous C reactive protein (CRP) (2.14 (1.71 to 2.68), I(2)=22.3%) and human leucocyte antigen B27 (HLA-B27) (1.81 (1.35 to 2.42), I(2)=0.0%) predict BASDAI50 response in AS. No factor was identified as a source of heterogeneity. Only meta-analysis of baseline BASFI showed risk of publication bias (Egger test, p=0.004). Similar results were found for ASAS criteria response. No predictors of response were identified in PsA.

Conclusions: Young age, male sex, high baseline BASDAI, low baseline BASFI, high baseline CRP and HLA-B27 predict better response to TNF antagonists in AS but not in PsA.

No MeSH data available.


Related in: MedlinePlus