title: Predictors of response to anti-TNF therapy in RA patients with moderate or high DAS28 scores.
abstract: OBJECTIVE
  To identify the clinical factors predicting a good clinical response to anti-TNF therapy in rheumatoid arthritis (RA) patients entered in the LORHEN registry after 5years of treatment with anti-TNF agents and divided into two groups on the basis of their baseline DAS28 scores (moderate>3.2-5.1 [MDA] and high>5.1 [HDA]).
  
  
  METHODS
  Disease activity at baseline and after 12months was assessed using the DAS28, and response was evaluated using the EULAR improvement criteria.
  
  
  RESULTS
  The study involved 1300 patients with established RA: 975 with HDA and 325 with MDA. After a mean 36-month, 29.6% of the patients had a DAS28 score of less or equal to 2.6 (HDA 25.8% vs. MDA 43.0%; P<0.001) and were considered to be in remission. A higher probability of a good EULAR response in patients with HDA was associated with male gender (F vs. M - OR 0.45, 95% CI 0.26-0.78; P: 0.004), lower age at the start of treatment (OR 0.98, 95% CI 0.96-0.99; P: 0.002), the absence of comorbidities (OR 0.18, 95% CI 0.06-0.52; P: 0.002) or no previous use of corticosteroids (OR 1.92, 95% CI 1.14-3.22; P: 0.015) and the use of adalimumab vs. infliximab (OR 2.21, 95% CI 1.37-3.57; P 0.001); in patients with MDA, the probability of a good EULAR response was associated with male gender (F vs. M - OR 0.39, 95% CI 0.17-0.90; P: 0.027).
  
  
  CONCLUSIONS
  With the exception of male gender, the factors predicting a good EULAR response are different in patients with MDA and those with HDA.
authors.affiliation: Rheumatology Unit, L.Sacco University Hospital of Milan, Milan, Italy. Electronic address: atzenifabiola@hotmail.com.
authors.forename: Fabiola
authors.initials: F
authors.lastname: Atzeni
authors.affiliation: Rheumatology Unit, L.Sacco University Hospital of Milan, Milan, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Bongiovanni
authors.affiliation: Day Hospital of Rheumatology, G. Pini Orthopedic Institute, Chair of Rheumatology in Milan, Milan, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Marchesoni
authors.affiliation: Rheumatology and Immunology Unit, Spedali Civili di Brescia, Brescia, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Filippini
authors.affiliation: Chair of Rheumatology, IRCCS Policlinico S. Matteo, Pavia, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Caporali
authors.affiliation: Rheumatology and Immunology Unit, Spedali Civili di Brescia, Brescia, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Gorla
authors.affiliation: Chair of Rheumatology, IRCCS Policlinico S. Matteo, Pavia, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Cavagna
authors.affiliation: Day Hospital of Rheumatology, G. Pini Orthopedic Institute, Chair of Rheumatology in Milan, Milan, Italy.
authors.forename: Ennio Giulio
authors.initials: EG
authors.lastname: Favalli
authors.affiliation: Internal Medicine, Ospedale di Saronno, A.O. Busto Arsizio, Saronno, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Saccardo
authors.affiliation: Rheumatology Unit, L.Sacco University Hospital of Milan, Milan, Italy.
authors.forename: Piercarlo
authors.initials: P
authors.lastname: Sarzi-Puttini
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012042:Registries; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha
keywords: Anti-TNF; DAS28 scores; High and moderate disease activity; Predictive factors