Journal Article

Extracellular matrix turnover biomarkers reflect pharmacodynamic effects and treatment response of adalimumab in patients with axial spondyloarthritis—results from two randomized controlled trials

Sørensen, Inge Juul, Østergaard, Mikkel, Holm Nielsen, Signe, Port, Helena, Bay-Jensen, Anne-Christine, Jensen, Bente, Loft, Anne Gitte, Pedersen, Susanne Juhl, Frederiksen, Peder, Madsen, Sofie Falkenløve, Madsen, Ole Rintek

2023

Overview

Objective To investigate if extracellular matrix (ECM) blood-based biomarkers reflect the pharmacodynamic effect and response to TNF-α inhibitor therapy (adalimumab, ADA), in patients with axial spondyloarthritis (axSpA). Methods We investigated ECM biomarkers in two randomized, double-blind, placebo-controlled trials of axSpA patients (DANISH and ASIM, n  = 52 and n  = 49, respectively) receiving ADA 40 mg or placebo every other week for 12 and 6 weeks, respectively, and thereafter ADA to week 48. Serum concentrations of degraded type I (C1M), II (C2M, T2CM), III (C3M), IV (C4M), VI (C6M), type X (C10C) collagen; metabolite of C-reactive protein (CRPM), prolargin (PROM), citrullinated vimentin (VICM), calprotectin (CPa9-HNE); and formation of type II (PRO‑C2), III (PRO‑C3), and VI (PRO‑C6) turnover of type IV collagen (PRO-C4) were measured at baseline and weeks 6 or 12, 24, and 48. The pharmacodynamic effect and treatment response to ADA was evaluated by linear mixed models, and correlations between biomarkers and clinical scores were assessed by Spearman’s correlation. Results C1M, C3M, C4M, C6M, CRP, PRO-C4, and CPa9-HNE levels declined after 6 or 12 weeks in patients receiving ADA compared to placebo (all p  < 0.05). Patients with AS Disease Activity Score C-reactive protein (ASDAS CRP) major improvement and/or clinically important improvement had significantly higher C1M, C3M, C4M, C6M, and PRO-C4 levels than patients with no/low improvement at baseline (all p  < 0.05). Baseline levels of biomarkers showed weak to moderate correlations with ASDAS and structural damage scores. Conclusion ECM metabolites showed a pharmacodynamic effect and were associated with ASDAS response during TNF-α inhibitor treatment in patients with axSpA.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adalimumab / Adalimumab - therapeutic use / Ankylosing spondylitis / Arthritis / Axial Spondyloarthritis / Biological markers / Biomarkers / C-Reactive Protein / Cartilage / Clinical outcomes / Collagen / Complement C4 / Connective tissue / Drug therapy / Extracellular Matrix / Health aspects / Humans / Inflammation / Magnetic resonance imaging / Medicine / Medicine & Public Health / Monoclonal antibodies / Neutrophils / Orthopedics / Patients / Pharmacodynamics / Pharmacology, Experimental / Randomized Controlled Trials as Topic / Rheumatology / Testing / Tumor Necrosis Factor Inhibitors / Tumor Necrosis Factor-alpha / Tumor necrosis factor-TNF