Certolizumab Pegol Effective in Rheumatoid Arthritis Patients with high RA factor: Study

A recent post hoc analysis of the EXXELERATE study revealed that certolizumab pegol (CZP) sustained drug concentration and efficacy in rheumatoid arthritis (RA) patients with varying baseline rheumatoid factor (RF) levels compared to adalimumab (ADA). The findings were published in the Rheumatology journal.

Rheumatoid arthritis is a chronic autoimmune condition that often features elevated levels of RF, an antibody that targets the body’s own tissues and can exacerbate disease severity. RF levels are frequently used to gauge the aggressiveness of RA and predict treatment outcomes. In this study, baseline RF levels were divided into quartiles, with patients grouped into either ≤204 IU/ml (≤Q3) or >204 IU/ml (>Q3) RF categories. A total of 907 patients were included in the analysis, split almost evenly between those treated with CZP and ADA.

The finding suggest that, while CZP maintained stable drug concentration levels regardless of the RF baseline, ADA demonstrated a decrease in drug concentration for patients with RF levels above 204 IU/ml. The area under the curve (AUC), which measured overall drug exposure over time was lower in ADA-treated patients with high RF when compared to the ones with lower RF levels. This contrast highlights a potentially significant difference in drug pharmacokinetics between the two TNF inhibitors, especially in patients with high RF levels, which may impact drug efficacy.

When examining efficacy outcomes, the study used the disease activity score (DAS28)-CRP to measure changes in disease activity. For patients with RF levels ≤204 IU/ml, both CZP and ADA provided similar improvements in DAS28-CRP scores over the 104-week period. However, in the higher RF group (>204 IU/ml), CZP outperformed ADA, leading to a notably lower mean DAS28-CRP score by week 104. Also, a higher percentage of patients with high RF levels treated with CZP achieved low disease activity status by the end of the study when compared to the individuals on ADA.

These findings suggest that for RA patients with elevated RF levels, CZP may offer superior long-term efficacy and drug stability when compared to ADA. Overall, the EXXELERATE study results reinforce the need for tailored therapeutic strategies based on individual patient factors, such as RF levels, when selecting TNF inhibitors for RA management.

Source:

Smolen, J. S., Taylor, P. C., Tanaka, Y., Takeuchi, T., Hashimoto, M., Cara, C., Lauwerys, B., Tilt, N., Ufuktepe, B., Xavier, R. M., Balsa, A., Curtis, J. R., Mikuls, T. R., & Weinblatt, M. (2024). Impact of high rheumatoid factor levels on treatment outcomes with certolizumab pegol and adalimumab in patients with rheumatoid arthritis. In Rheumatology. Oxford University Press (OUP). https://doi.org/10.1093/rheumatology/keae435