title: Infliximab equivalently suppresses oxidative stress compared to tocilizumab among well-controlled patients with rheumatoid arthritis.
abstract: OBJECTIVE
  This study was designed to investigate which biological agent, infliximab or tocilizumab, would more intensively keep suppressing oxidative stress among well-controlled patients as C-reactive protein (CRP) levels normalized in rheumatoid arthritis (RA). In addition, it was intended to clarify indicative factors of oxidative stress among well-controlled patients with RA.
  
  
  METHODS
  We recruited 61 well-controlled (CRP < 0.3 mg/dL within normal ranges) patients with RA using biological agents (infliximab n = 33; tocilizumab n = 28), active RA patients with CRP > 1.0 mg/dL (n = 10) and healthy subjects (n = 10) and examined the fraction of oxidized albumin (oxidized-albumin [%]) as a marker of oxidative stress in addition to inflammatory measures and disease activity scores such as CRP, erythrocyte sedimentation rate (ESR), matrix metalloproteinase 3 (MMP-3), serum amyloid A (SAA), Clinical Disease Activity Index, Simplified Disease Activity Index, visual analog scale (VAS), Disease Activity Index of 28 joints (DAS28)-CRP, DAS28-ESR and renal function (creatinine clearance [CCr]).
  
  
  RESULTS
  Oxidized-albumin (%) was significantly elevated among active RA patients (33.83 ± 5.31%) as compared with healthy subjects (23.00 ± 2.56%). Although oxidized-albumin (%) among well-controlled RA patients also increased, there was no difference with oxidized-albumin (%) between infliximab and tocilizumab groups (26.40 ± 5.44% in infliximab; 26.62 ± 4.53% in tocilizumab). In Pearson's correlation, oxidized-albumin (%) had significant correlations with CRP, MMP-3, ESR, SAA, age, CCr, VAS, DAS28-CRP and DAS28-ESR. With those variables, multiple stepwise forward regression analysis was conducted and revealed that CCr, DAS28-ESR and CRP are the statistically significant explanatory variables on oxidized-albumin (%) among well-controlled RA patients.
  
  
  CONCLUSIONS
  We demonstrated that there was no difference with infliximab and tocilizumab on oxidative stress and we clarified that CCr, DAS28-ESR and CRP become indicative factors of oxidative stress among well-controlled RA patients.
authors: Department of Orthopaedic Surgery and Rheumatology, Kyoto Shimogamo Hospital, Kyoto, Japan.
authors: Kazuha
authors: K
authors: Kizaki
authors: Department of Orthopaedic Surgery and Rheumatology, Kyoto Shimogamo Hospital, Kyoto, Japan.
authors: Fumiharu
authors: F
authors: Yamashita
authors: Department of Sports Science, Meiji University of Integrative Medicine, Kyoto, Japan.
authors: Tomoya
authors: T
authors: Hayashi
authors: Department of Orthopaedic Surgery and Rheumatology, Kyoto Shimogamo Hospital, Kyoto, Japan.
authors: Noboru
authors: N
authors: Funakoshi
mesh_terms: D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects / Q000627:therapeutic use*; D000975:Antioxidants / Q000009:adverse effects / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D015415:Biomarkers / Q000097:blood; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000378:metabolism; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D000069285:Infliximab / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D019278:Matrix Metalloproteinase 3 / Q000097:blood; D008875:Middle Aged; D010084:Oxidation-Reduction; D018384:Oxidative Stress / Q000187:drug effects*; D000075462:Serum Albumin, Human / Q000378:metabolism; D000685:Serum Amyloid A Protein / Q000378:metabolism; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000975:Antioxidants; D018501:Antirheumatic Agents; D015415:Biomarkers; D018836:Inflammation Mediators; D000685:Serum Amyloid A Protein; D002097:C-Reactive Protein; D000069285:Infliximab; C511768:MMP3 protein, human; D019278:Matrix Metalloproteinase 3; C502936:tocilizumab; D000075462:Serum Albumin, Human
keywords: albumin; infliximab; rheumatoid arthritis; tocilizumab