High survivin levels predict poor clinical response to infliximab treatment in patients with rheumatoid arthritis.
OBJECTIVE
To evaluate if the measurement of survivin in the blood of patients with rheumatoid arthritis (RA) undergoing infliximab treatment has predictive value for treatment response.


METHODS
The study included 87 consecutive RA patients (age 24-89 years, disease duration 18-526 months) treated with regular infusions of influximab. Survivin levels were measured by enzyme-linked immunosorbent assay and evaluated in relation to the total dose of infliximab, disease activity (DAS28), response to infliximab treatment (change in DAS28 >1.2), and radiographic damage (vdH-Sharp score).


RESULTS
Thirty-seven percent of patients were survivin-positive (survivin >0.9 ng/mL) and showed severe radiographic damage at the start of infliximab treatment compared with survivin-negative (P = 0.027). Patients with high survivin levels were unlikely to respond to infliximab treatment (OR 4.02 [1.22-14.61], P = 0.022) and achieve remission (OR 4.32[1.01-30.11], P = 0.048) compared with patients with low survivin levels.


CONCLUSIONS
High survivin levels are associated with severe radiographic damage at the start of treatment and a poor response to infliximab. Survivin measurement should be considered an additional tool for aiding the selection and follow-up of antirheumatic treatment.
Department of Rheumatology and Inflammation Research, Sahlgrenska University Hospital, University of Göteborg, Göteborg, Sweden.
Anniella
A
Isgren
Kristina
K
Forslind
Malin
M
Erlandsson
Carl
C
Axelsson
Sofia
S
Andersson
Anneli
A
Lund
Maria
M
Bokarewa
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D001175:Arthrography; D005260:Female; D006304:Health Status; D006801:Humans; D000069285:Infliximab; D051034:Inhibitor of Apoptosis Proteins / Q000097:blood*; D007596:Joints / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012074:Remission Induction; D012720:Severity of Illness Index; D000077022:Survivin; D016896:Treatment Outcome; D055815:Young Adult
D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; C107489:BIRC5 protein, human; D051034:Inhibitor of Apoptosis Proteins; D000077022:Survivin; D000069285:Infliximab