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Based on clinical trial data, patients starting tumour necrosis factor-alpha inhibitors (TNFi) have roughly a two-thirds chance of achieiving a good clinical response. French investigators have studied a series of potential biomarkers and surmised that the combination of baseline prealbumin, platelet factor 4 and S100A12 can predict a 78% response to TNFi in rheumatoid arthritis (RA) patients.
They sought to identify potential of protein biomarkers that could be used to predict clinical response to TNFi by studying a cohort of RA patients and measuring baseline blood levels of C-reactive protein, platelet factor 4, apolipoprotein A1, prealbumin, α1-antitrypsin, haptoglobin, S100A8/A9 and S100A12 proteins in bDMARD naive patients at the time of TNFi initiation.
The best fit for a predictive clinical response was seen with a combination of biomarkers (prealbumin, platelet factor 4 and S100A12) that could predict TNFi responses with a sensitivity of 78%, specificity of 77%, positive predictive values (PPV) of 72%, negative predictive values (NPV) of 82%, positive likelihood ratio (LR + ) of 3.35 and negative likelihood ratio (LR-) of 0.28.
TNFi responders had lower levels of prealbumin and S100A12 and higher levels of platelet factor 4 were good predictors for response to TNFi treatment with either Infliximab, etanercept or adalimumab
Further studies in a larger, wider RA population are needed to confirm the utility of using such protein assays.