Abstract: Anti-citrullinated peptide antibodies (ACPAs)
play an important pathogenic role both at the onset and
during the disease course. These antibodies precede the
clinical appearance of rheumatoid arthritis (RA) and are
associated with a less favorable prognosis, both clinically
and radiologically. The objective of this work was to conduct
a comprehensive review of studies published through
September 2015 of ACPAs? role as a predictor of the therapeutic
response to the biological agents in RA patients. The
review also includes summary of the biology and detection
of ACPAs as well as ACPAs in relation to joint disease and
CV disease and the possible role of seroconversion. The
reviews of studies examining TNF inhibitors and tocilizumab
yielded negative results. In the case of rituximab,
the data indicated a greater probability of clinical benefit in ACPA+ patients versus ACPA? patients, as has been
previously described for rheumatoid factor. Nonetheless,
the effect is discreet and heterogeneous. Another drug that
may have greater effectiveness in ACPA+ patients is abatacept.
Some studies have suggested that the drug is more
efficient in ACPA+ patients and that those patients show
greater drug retention. In a subanalysis of the AMPLE trial,
patients with very high ACPA titers who were treated with
abatacept had a statistically significant response compared
to patients with lower titers. In summary, the available
studies suggest that the presence of or high titers of ACPA
may predict a better response to rituximab and/or abatacept.
Evidence regarding TNFi and tocilizumab is lacking.
However, there is a lack of studies with appropriate designs
to demonstrate that some drugs are superior to others for
ACPA+ patients.