High Baseline Neutrophil-to-Lymphocyte Ratio Could Serve as a Biomarker for Tumor Necrosis Factor-Alpha Blockers and Their Discontinuation in Patients with Ankylosing Spondylitis

Abstract

Background: This study explores the association of neutrophil-to-lymphocyte (NLR), monocyte-to-lymphocyte (MLR), and platelet-to-lymphocyte (PLR) ratios with the 3-month treatment response and persistence of tumor necrosis factor-alpha (TNF-α) blockers in patients with ankylosing spondylitis (AS). Methods: This retrospective cohort study investigated 279 AS patients who were newly initiated on TNF-α blockers between April 2004 and October 2019 and 171 sex- and age-matched healthy controls. Response to TNF-α blockers was defined as a reduction in the Bath AS Disease Activity Index of ≥50% or 20 mm, and persistence referred to the time interval from the initiation to discontinuation of TNF-α blockers. Results: Patients with AS had significantly increased NLR, MLR, and PLR ratios as compared to controls. The frequency of non-response at 3 months was 3.7%, and TNF-α blockers’ discontinuation occurred in 113 (40.5%) patients during the follow-up period. A high baseline NLR but not high baseline MLR and PLR showed an independently significant association with a higher risk of non-response at 3 months (OR = 12.3, p = 0.025) and non-persistence with TNF-α blockers (HR = 1.66, p = 0.01). Conclusions: NLR may be a potential marker for predicting the clinical response and persistence of TNF-α blockers in AS patients.

Drug Persistence and Incidence of Active Tuberculosis of Tumor Necrosis Factor Alpha Inhibitors Versus Tocilizumab as the First-Line Biological Treatment in Patients with Rheumatoid Arthritis: A Nationwide Population-Based Retrospective Cohort Analysis

“…Drug persistence may be a surrogate marker that reflects both long-term efficacy and safety in clinical settings [9]. Thus, selecting medications with better long-term persistence may be more appropriate for optimizing clinical outcomes in patients with chronic diseases, such as RA, who need to maintain lifelong therapy.…”

The Usefulness of Cellular Immune Inflammation Markers and Ultrasound Evaluation in the Assessment of Disease Activity in Patients with Spondyloarthritis

“…The hematological markers of systemic inflammation, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), or monocyte-to-lymphocyte ratio (MLR) were estimated to be highly sensitive markers of inflammation in diseases such as cancer, neurological or cardiovascular conditions, systemic autoimmune rheumatic diseases [7][8][9]. They were also examined as indicators of systemic inflammation in patients with SpA [10][11][12][13][14][15], however, with conflicting results. The NLR value was higher in patients with axSpA than in controls and exhibited a correlation with CRP [10,13,15], or there was no significant difference between AS patients and controls [9,11].…”

“…The NLR value was higher in patients with axSpA than in controls and exhibited a correlation with CRP [10,13,15], or there was no significant difference between AS patients and controls [9,11]. The PLR value was significantly higher [9,12,13,15], and there was no significant difference between patients with AS and controls [11]. The NLR was reported to be a marker for predicting the therapeutic effect and persistence of anti-tumor necrosis factor-α (TNF-α) treatment [14].…”