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Suppression of Serum Interferon‐γ Levels as a Potential Measure of Response to Ustekinumab Treatment in Patients With Systemic Lupus Erythematosus
Author(s) -
Cesaroni Matteo,
Seridi Loqmane,
Loza Matthew J.,
Schreiter Jessica,
Sweet Kristen,
Franks Carol,
Ma Keying,
Orillion Ashley,
Campbell Kim,
M. Gordon Robert,
Branigan Patrick,
Lipsky Peter,
Vollenhoven Ronald,
Hahn Bevra H.,
Tsokos George C.,
Chevrier Marc,
Rose Shawn,
Baribaud Frédéric,
Jordan Jarrat
Publication year - 2021
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.41547
Subject(s) - ustekinumab , medicine , placebo , randomization , gastroenterology , randomized controlled trial , immunology , disease , pathology , infliximab , alternative medicine
Objective In a previously reported phase II randomized, placebo‐controlled, interventional trial, we demonstrated that treatment with ustekinumab, an anti–interleukin‐12 (IL‐12)/IL‐23 p40 neutralizing monoclonal antibody, improved global and organ‐specific measures of disease activity in patients with active systemic lupus erythematosus (SLE). Utilizing the biomarker data from this phase II clinical study, we sought to determine whether modulation of the expression of IL‐12, IL‐23, or both cytokines by ustekinumab is associated with clinical efficacy in patients with SLE. Methods This phase II randomized, placebo‐controlled study enrolled 102 patients with autoantibody‐positive SLE whose disease remained active despite standard‐of‐care therapy. Patients were randomized at a 3:2 ratio to receive ~6 mg/kg ustekinumab intravenously or placebo at week 0, followed by subcutaneous injections of 90 mg ustekinumab or placebo every 8 weeks, with placebo crossover to 90 mg ustekinumab every 8 weeks. The SLE Responder Index 4 (SRI‐4) at week 24 was used to determine which patients could be classified as ustekinumab responders and which could be classified as nonresponders. In addition to measurements of p40 and IL‐23, serum levels of interferon‐γ (IFNγ), IL‐17A, IL‐17F, and IL‐22, as a proxy for the IL‐12 and IL‐23 pathways, were quantified by immunoassay. Results Changes in the serum levels of IL‐17A, IL‐17F, and IL‐22 at different time points after treatment were not consistently significantly associated with an SRI‐4 clinical response to ustekinumab in patients with SLE. In contrast, an SRI‐4 response to ustekinumab was significantly associated ( P < 0.01) with durable reductions in the serum IFNγ protein levels at several time points relative to baseline, which was not observed in ustekinumab nonresponders or patients who received placebo. Conclusion While not diminishing a potential role of IL‐23, these serum biomarker assessments indicate that IL‐12 blockade has an important role in the mechanism of action of ustekinumab treatment in patients with SLE.