title: Lack of response to anakinra in rheumatoid arthritis following failure of tumor necrosis factor alpha blockade.
abstract: OBJECTIVE
  In patients with rheumatoid arthritis (RA) treated with tumor necrosis factor alpha (TNF alpha)- blocking therapy, there is heterogeneity of response. This raises the possibility that in certain circumstances, cytokines such as interleukin-1 (IL-1) may dominate the drive toward joint inflammation. This study was undertaken to investigate whether blocking the action of IL-1 with an IL-1 receptor antagonist (IL-1Ra) is efficacious in patients with disease that did not respond to TNF alpha blockade.
  
  
  METHODS
  We identified 26 RA patients whose disease had failed to respond to TNF alpha-blocking therapy, defined as failure to achieve or sustain a 20% improvement in disease activity according to the criteria of the American College of Rheumatology (ACR20 response). These patients were then treated with anakinra (100 mg/day subcutaneously) for 12 weeks, and their levels of response were assessed.
  
  
  RESULTS
  After 3 months of anakinra therapy, only 2 of 26 patients (8%) achieved an ACR20 response; none achieved an ACR50 or ACR70 response. A rise in the mean C-reactive protein level and an increase in the mean swollen joint count were noted during the study period.
  
  
  CONCLUSIONS
  This study demonstrates that patients with disease that fails to respond to TNF alpha blockade also do not respond to IL-1Ra. These data do not provide evidence of a dominant role for IL-1 in patients who do not respond to TNF alpha blockade, but they do not exclude a role for other proinflammatory mediators.
authors.affiliation: University of Leeds, Leeds, UK.
authors.forename: Maya H
authors.initials: MH
authors.lastname: Buch
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Bingham
authors.forename: Yohei
authors.initials: Y
authors.lastname: Seto
authors.forename: Dennis
authors.initials: D
authors.lastname: McGonagle
authors.forename: Victoria
authors.initials: V
authors.lastname: Bejarano
authors.forename: Jo
authors.initials: J
authors.lastname: White
authors.forename: Paul
authors.initials: P
authors.lastname: Emery
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D002097:C-Reactive Protein / Q000378:metabolism; D005260:Female; D006801:Humans; D053590:Interleukin 1 Receptor Antagonist Protein; D007596:Joints / Q000473:pathology; D008297:Male; D008875:Middle Aged; D019233:Retreatment; D012795:Sialoglycoproteins / Q000627:therapeutic use*; D017211:Treatment Failure; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D018501:Antirheumatic Agents; C507763:IL1RN protein, human; D053590:Interleukin 1 Receptor Antagonist Protein; D012795:Sialoglycoproteins; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein