title: Predictive factors of abatacept therapy discontinuation in patients with rheumatoid arthritis.
abstract: The aim of this paper was to look for predictors of abatacept (ABA) therapy discontinuation in patients with rheumatoid arthritis (RA). Seventy-one RA patients treated with ABA were followed up. Demographical, clinical, and laboratory parameters of the patients, including peripheral blood T and B cell populations, different rheumatoid factor and anti-cyclic citrullinated peptide autoantibodies isotypes, and serum free light chains were evaluated. Comparing patients who discontinued ABA with those still in therapy we observed: a higher proportion of smokers (51.9 vs 25.6 %; p = 0.03); a non significant lower proportion of anti-cyclic citrullinated peptide positivity (76 vs 89.5 %; p = 0.13); a lower proportion of terminally differentiated effector memory cells (TDEM) among total CD8+ T lymphocytes at baseline (22.0 % (7.8-39.2) vs 38.7 % (20.7-55.9); p = 0.002). Logistic multivariate analysis showed that only the proportion of CD8+TDEM T cells was an independent predictive factor of therapy discontinuation (OR (95 % IC) = 6.2 (1.2 to 30.8); p = 0.026). Receiver-operating characteristic analysis showed a significant performance of this biomarker for prediction of therapy discontinuation (using a cut-off of 30.6 %: AUC: 0.760 ± 0.07; p = 0.002). Patients with a low proportion of CD8+TDEM at baseline had a higher probability of discontinuing the treatment during time (log-rank test: p < 0.01). T cell characterization for identification of TDEM CD8+ T cells might be a useful test to predict discontinuation of ABA therapy.
authors.affiliation: Rheumatology and Clinical Immunology Unit, Spedali Civili of Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy. slv.piantoni@gmail.com.|Rheumatology Chair, University of Pavia, Pavia, Italy. slv.piantoni@gmail.com.|Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy. slv.piantoni@gmail.com.
authors.forename: Silvia
authors.initials: S
authors.lastname: Piantoni
authors.affiliation: Rheumatology and Clinical Immunology Unit, Spedali Civili of Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Colombo
authors.affiliation: Rheumatology and Clinical Immunology Unit, Spedali Civili of Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy.|Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
authors.forename: Angela
authors.initials: A
authors.lastname: Tincani
authors.affiliation: Rheumatology and Clinical Immunology Unit, Spedali Civili of Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Airò
authors.affiliation: Rheumatology and Clinical Immunology Unit, Spedali Civili of Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy.|Internal Medicine Unit, Esine-Vallecamonica Hospital, ASL Vallecamonica-Sebino, Esine, Italy.
authors.forename: Mirko
authors.initials: M
authors.lastname: Scarsi
mesh_terms: D000069594:Abatacept / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000008:administration & dosage; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000276:immunology*; D001323:Autoantibodies / Q000276:immunology; D001402:B-Lymphocytes / Q000166:cytology; D015415:Biomarkers / Q000378:metabolism; D018414:CD8-Positive T-Lymphocytes / Q000166:cytology*; D002454:Cell Differentiation; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007156:Immunologic Memory; D008297:Male; D008875:Middle Aged; D010352:Patient Dropouts; D010456:Peptides, Cyclic / Q000276:immunology; D012372:ROC Curve; D012217:Rheumatoid Factor / Q000276:immunology; D012306:Risk; D012680:Sensitivity and Specificity; D013601:T-Lymphocytes / Q000166:cytology*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D001323:Autoantibodies; D015415:Biomarkers; D010456:Peptides, Cyclic; C487763:cyclic citrullinated peptide; D000069594:Abatacept; D012217:Rheumatoid Factor
keywords: Abatacept; Predictive factors; Rheumatoid arthritis; T cells
references.citation: Rheumatology (Oxford). 2006 Dec;45(12):1558-65
references.pmid: 16705046
references.citation: Arthritis Rheumatol. 2015 May;67(8):2273-4
references.pmid: 25940866
references.citation: Ann Rheum Dis. 2013 Mar;72(3):329-36
references.pmid: 22689315
references.citation: Int J Mol Sci. 2014 Dec 03;15(12):22279-95
references.pmid: 25479074
references.citation: Ann Rheum Dis. 2012 Nov;71(11):1815-9
references.pmid: 22615458
references.citation: J Chronic Dis. 1987;40(5):373-83
references.pmid: 3558716
references.citation: J Rheumatol. 2010 May;37(5):911-6
references.pmid: 20231200
references.citation: J Rheumatol. 2015 May;42(5):786-93
references.pmid: 25834204
references.citation: J Rheumatol. 2011 Oct;38(10):2105-11
references.pmid: 21807779
references.citation: Ann Rheum Dis. 2009 Jun;68(6):954-60
references.pmid: 18490431
references.citation: Ann Rheum Dis. 2014 Mar;73(3):492-509
references.pmid: 24161836
references.citation: Eur J Immunol. 2004 Dec;34(12):3525-33
references.pmid: 15484193
references.citation: Ann Rheum Dis. 2015 Feb;74(2):375-80
references.pmid: 24276366
references.citation: J Rheumatol. 2014 Apr;41(4):666-72
references.pmid: 24584924
references.citation: Semin Arthritis Rheum. 2013 Aug;43(1):9-17
references.pmid: 23290690
references.citation: J Rheumatol. 2014 Sep;41(9):1761-5
references.pmid: 25128506
references.citation: Ann Rheum Dis. 2011 Jul;70(7):1216-22
references.pmid: 21551512