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Brief Report: Attenuated Effectiveness of Tumor Necrosis Factor Inhibitors for Anti–Human T Lymphotropic Virus Type I Antibody–Positive Rheumatoid Arthritis
Author(s) -
Suzuki Takahisa,
Fukui Shoichi,
Umekita Kunihiko,
Miyamoto Junya,
Umeda Masataka,
Nishino Ayako,
Okada Akitomo,
Koga Tomohiro,
Kawashiri Shinya,
Iwamoto Naoki,
Ichinose Kunihiro,
Tamai Mami,
Fujikawa Keita,
Aramaki Toshiyuki,
Mizokami Akinari,
Matsuoka Naoki,
Ueki Yukitaka,
Eguchi Katsumi,
Sato Shuntaro,
Hidaka Toshihiko,
Origuchi Tomoki,
Okayama Akihiko,
Kawakami Atsushi,
Nakamura Hideki
Publication year - 2018
Publication title -
arthritis and rheumatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.106
H-Index - 314
eISSN - 2326-5205
pISSN - 2326-5191
DOI - 10.1002/art.40461
Subject(s) - rheumatoid arthritis , antibody , medicine , tumor necrosis factor alpha , human t lymphotropic virus , immunology , virus , virology , tumor necrosis factor α , arthritis , psychiatry , myelopathy , spinal cord
Objective To evaluate the effectiveness of tumor necrosis factor ( TNF ) inhibitors for the treatment of human T lymphotropic virus type I ( HTLV ‐I)–positive patients with rheumatoid arthritis ( RA ) in an area endemic for HTLV ‐I infection. Methods We conducted an observational study of 585 RA patients in whom TNF inhibitors were newly introduced as a first biologic disease‐modifying antirheumatic drug in an area in southwestern Japan that is endemic for HTLV ‐I infection. Results Fifty patients (8.5%) were anti– HTLV ‐I antibody–positive. The ages of the patients in this group were significantly higher at entry compared with the ages of patients who were anti– HTLV ‐I antibody–negative (n = 535). The median Disease Activity Score in 28 joints using the erythrocyte sedimentation rate ( DAS 28‐ ESR ) was 5.21. Among the total group of patients, 82% were anti–citrullinated protein antibody ( ACPA )–positive. The persistence rate of TNF inhibitors at 24 weeks was 89%. The median DAS 28‐ ESR was significantly decreased at 24 weeks in each group. The European League Against Rheumatism ( EULAR ) response rate was significantly better in the anti– HTLV ‐I antibody–negative patients ( P = 0.0277). Multiple regression analysis demonstrated that anti– HTLV ‐I antibody status was significantly associated with the EULAR response rate and change in the DAS 28‐ ESR and was prominent especially in the ACPA ‐negative subjects. No patients developed adult T cell leukemia/lymphoma ( ATL ) or HTLV ‐I–associated myelopathy ( HAM ) during the 24‐week treatment period. Conclusion The efficacy of TNF inhibitors may be attenuated in anti– HTLV ‐I antibody–positive patients with RA . ATL and HAM did not develop when TNF inhibitors were used for 24 weeks, but the long‐term risk is not known.