Predictors of tumor necrosis factor inhibitors primary failure in rheumatoid arthritis patients

Tumor necrosis factor inhibitors (TNFi) have emerged as an efficient therapeutic modality for rheumatoid arthritis (RA). A ratio of patients does not give a response despite therapy. It remains a challenge to predict which patients will respond. Our study aims to investigate early predictors of primary TNFi failure in RA patients. Patients were categorized into two groups based on TNFi therapy (responder/non-responder) and then compared to detect the most significant predictors of treatment failure.

This study included 87 RA patients treated with TNFi for the first time after conventional disease-modifying anti-rheumatic drugs (DMARDs) failed. This study showed that compared to those with successful treatment, patients with overall primary failure were significantly higher in older age, females, smokers, obese, younger age at the onset of the disease, or those with deformity. In addition, the drug failure was significantly related to erythrocyte sedimentation rate (ESR) (100 vs 68 mm/h), C-reactive protein (CRP) (48 vs 12 mg/dl), rheumatoid factor (RF) positivity (29% vs 16%), anti-cyclic citrullinated peptide (anti-CCP) positivity (39% vs 23%), and non-methotrexate (MTX) concomitant use (33% vs 40%).

The increased age, being a smoker, earlier age at onset, presence of a deformity, and positive anti-CCP at baseline were predictors of overall failure. At the same time, concomitant MTX intake increased the success rate by 9.6%.