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Variants of Genes Implicated in Type 1 Interferon Pathway and B-Cell Activation Modulate the EULAR Response to Rituximab at 24 Weeks in Rheumatoid Arthritis

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Variants of Genes Implicated in Type 1 Interferon Pathway and B-Cell Activation Modulate the EULAR Response to Rituximab at 24 Weeks in Rheumatoid Arthritis RMD Open: first published as 10.1136/rmdopen-2017-000448 on 28 September 2017. Downloaded from Rheumatoid arthritis ORIGINAL article Variants of genes implicated in type 1 interferon pathway and B-cell activation modulate the EULAR response to rituximab at 24 weeks in rheumatoid arthritis Pierre-Antoine Juge,1 Steven Gazal,2 Arnaud Constantin,3,4 Xavier Mariette,5,6 Bernard Combe,7 Jacques Tebib,8 Maxime Dougados,9,10 Jean Sibilia,11 Xavier Le Loet,12 Philippe Dieudé1,13 To cite: Juge P-A, Gazal S, ABSTRACT Constantin A, et al. Variants Background The type 1 interferon (IFN) pathway has been Key messages of genes implicated in type identified to potentially affect the response to rituximab 1 interferon pathway and (RTX) for rheumatoid arthritis (RA), which suggests the What is already known about this subject? B-cell activation modulate contribution of type 1 IFN pathway genes such as IFN ► Type 1 interferon (IFN) pathway has been identified the EULAR response to to potentially affect the rituximab (RTX) response in regulatory factor 5 and 7 (IRF5 and IRF7), tyrosine kinase rituximab at 24 weeks in rheumatoid arthritis (RA). rheumatoid arthritis. RMD Open 2 (TYK2), signal transducer and activator of transcription 2017;3:e000448. doi:10.1136/ 4 (STAT4) and osteopontin (SPP1). Our objective was to What does this study add? rmdopen-2017-000448 study functional variants of these IFN pathway genes as ► Our results suggest an impact of genetic predictors of the European League Against Rheumatism variations of IRF5 and SPP1, involved in the type (EULAR) response to RTX for RA at week 24 (W24). ► Prepublication history for 1 IFN pathway, on the response to RTX in RA at Methods Logistic regression analysis with a stepwise this paper is available online. week 24 (W24) multivariate model adjusted for sex, age and DAS28-CRP To view these files please visit In this study, we found a strong association of (Disease Activity Score in 28 joints with C reactive protein) ► the journal online (http:// dx. doi. the allelic combination of IRF5 rs2004640, SPP1 http://rmdopen.bmj.com/ in 115 patients from the SMART randomised studywas org/ 10. 1136/ rmdopen- 2017- rs9138 and TNFSF13B rs9514828 and response to 000448). used to analyse the association between the candidate RTX in RA at W24. This finding requires replication variants and W24 EULAR response. Because the variant in independent populations to further definitely Received 1 February 2017 TNFSF13B rs9514828 was previously found associated conclude that the IRF5 SPP1 TNSF13B risk allelic Revised 13 September 2017 with RTX response in the same population, it was included – – Accepted 14 September 2017 in the analysis. combination is a strong predictive marker of the RTX response in RA. Results The combination of IRF5 rs2004640, SPP1 rs9138 and TNFSF13B rs9514828 was strongly associated How might this impact on clinical practice? with good/moderate EULAR response to RTX at W24: on September 28, 2021 by guest. Protected copyright. −6 ► If replicated, exploring this allelic combination p=9.34×10 , OR 11.37 (95% CI 4.03 to 35.28), positive before the introduction of RTX could be useful for a predictive value 91% and negative predictive value 54%. personalised therapeutic strategy in RA. Conclusion Our results support the contribution of the IRF5, SPP1 and TNFSF13B genotypic combination in the response to RTX for RA at W24. will not respond to a given treatment, nor do we understand the pathogenesis underlying these interindividual variances.3 To improve BACKGROUND this situation, the identification of prognostic Rheumatoid arthritis (RA) is a complex factors of RTX response is needed. systemic autoimmune disorder with environ- The type 1 interferon (IFN) pathway was mental, genetic and stochastic factors impli- recently identified to potentially affect the cated.1 The anti-CD20 chimeric monoclonal RTX response in RA. Indeed, transcrip- antibody that targets B cells, rituximab (RTX), tome studies found that the only distinction For numbered affiliations see is an effective treatment for RA refractory to between RTX responders and non-responders end of article. tumour necrosis factor blockers.2 Currently, at week 24 (W24) was pharmacodynamic Correspondence to we cannot offer personalised medicine for changes in the expression of a selective group 4 5 Pr Philippe Dieudé; patients with RA receiving biologics, including of genes all regulated by type 1 IFN. As philippe. dieude@ aphp. fr RTX, because we cannot identify those who well, the pharmacological effect of RTX on Juge P-A, et al. RMD Open 2017;3:e000448. doi:10.1136/rmdopen-2017-000448 1 RMD Open: first published as 10.1136/rmdopen-2017-000448 on 28 September 2017. Downloaded from RMD Open IFN-response gene activity was found associated with patients gave their informed consent according to the IFN-response activity before the start of treatment.5 6 Declaration of Helsinki. Several genes encoding proteins that are key compo- nents of the type 1 IFN system include IFN regulatory Selection of single-nucleotide polymorphisms (SNPs) factor 5 and 7 (IRF5/7), tyrosine kinase 2 (TYK2), signal All patients underwent genotyping for the SNPs for IRF5 transducer and activator of transcription 4 (STAT4) and (rs2004640), IRF7 (rs1131665), STAT4 (rs7574865), osteopontin (SPP1). These genes have recently been TYK2 (rs2304256, rs280519 and rs12720356) and SPP1 found to play a role in the risk of several autoimmune (rs11439060 and rs9138). Genotyping was performed at diseases including RA.7–9 Here, we aimed to investigate KBiosciences, Manchester, UK. We selected these eight whether putative or proven functional variants of IRF5/7, variants by their previously reported putative or proven TYK2, STAT4 and SPP1 could modulate the European functional relevance in the type 1 IFN pathway.7–9 Because League Against Rheumatism (EULAR) response to RTX of the recently reported association between TNFSF13B in RA. (encoding BAFF) rs9514828 and RTX response in the SMART study,11 this variant was also integrated into the multivariate analysis. METHODS Study population Statistical analysis In this retrospective, multicentric study, all patients from The association between the variants and EULAR the SMART study (A Study of Re-treatment With MabThera response to RTX was analysed by logistic regression.12 (Rituximab) in Patients With Rheumatoid Arthritis Who Responders were defined by a good/moderate EULAR Have Failed on Anti-TNF Alfa Therapy) who consented response at W24. First, response rate was compared to genetic studies were included. Characteristics of the across risk genotypes by univariate analysis with the SMART study have been previously described.10 Briefly, χ2, with Yates’ continuity correction as appropriate. 224 patients fulfilling the 1987 American College of Both dominant and recessive models were tested, and Rheumatology criteria for RA with inadequate response, results of the most significant one were reported. Note intolerance or contraindication to anti-TNFα were that the additive model was also tested but results were included in the SMART study (NCT01126541), a 2-year not reported, as it did not improve the results. Varia- national multicentric randomised open-label study eval- bles significant at p<0.20 were selected, combined with uating the efficacy and safety of two doses of RTX for TNFSF13B rs9514828 and entered into a logistic regres- re-treatment after one course of RTX (1000 mg on days sion adjusted on sex, age and Disease Activity Score in 28 1 and 15). Only corticosteroids and non-steroidal anti-in- joints with C reactive protein (DAS28-CRP), rheumatoid flammatory drugs were permitted if at stable doses. B-cell factor (RF) and anti-Cyclic Citrullinated Peptide (CCP) activating factor (BAFF) level was measured at RTX initia- status. The best fitting model was determined using the tion using a Quantikine ELISA (R&D Systems). The main backward procedure implemented in the step function http://rmdopen.bmj.com/ SMART study was approved by the local ethics committee of R. ORs and 95% CIs were calculated. Conformity with (Groupe Hospitalier Pitié-Salpêtrière, Paris), and all Hardy-Weinberg equilibrium was tested by a classical χ2 Table 1 Overall characteristics of patients with rheumatoid arthritis by EULAR response to rituximab at week 24 (W24) Overall Good/moderate population (n=115) responders (n=92) Non-responders (n=22) on September 28, 2021 by guest. Protected copyright. Women, n (%) 92 (80.0) 73 (79.3) 18 (81.8) Age, mean±SD 55.50±11.15 55.47±11.33 55.77±10.84 Rheumatoid arthritis duration (year), mean±SD 14.06±9.29 14.07±9.55 14.25±8.54 Anti-CCP-positive, n (%) 93 (80.9) 75 (81.5) 17 (77.3) RF positive, n (%) 82 (71.3) 68 (73.9) 13 (59.1) Prednisone users, n (%) 87 (75.7) 66 (71.7) 20 (90.9) Prednisone dosage (mg/day), mean±SD 7.72±2.90 7.64±2.90 8.02±2.68 DAS28-CRP, mean±SD At initiation 5.68±0.90 5.76±0.87 5.34±0.97 At W24 3.94±1.07 3.63±0.84 5.23±0.98 DAS28-CRP change at W24, mean±SD −1.74±1.14 −2.13±0.87 −0.11±0.55 BAFF level at RTX initiation (pg/μL), mean±SD 588.34±364.51 590.89±368.23 475.8±50.20 DAS28-CRP, Disease Activity Score in 28 joints with C reactive protein; EULAR, European League Against Rheumatism; RF, rheumatoid factor; RTX, rituximab. 2 Juge P-A, et al. RMD Open 2017;3:e000448. doi:10.1136/rmdopen-2017-000448 RMD Open: first published as 10.1136/rmdopen-2017-000448 on 28 September 2017. Downloaded from Rheumatoid arthritis test with one degree of freedom in controls. All statistical Univariate analysis revealed an increase in the minor analyses involved the use of R V.3.1.2.
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