High baseline NLR predicts failure of triple therapy in rheumatoid arthritis

  • Semin Arthritis Rheum

  • von Miriam Davis, PhD
  • Clinical Essentials
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Takeaway

  • High baseline neutrophil-lymphocyte ratio (NLR, 2.70) predicts which patients with rheumatoid arthritis (RA) will fail triple therapy (methotrexate [MTX], sulfasalazine, and hydroxychloroquine) at 1 year.
  • Other inflammatory markers, including platelet-to-lymphocyte ratio (PLR), did not.

Why this matters

  • Baseline NLR 2.70 in patients with RA may provide an inexpensive, objective, and reproducible prognostic biomarker, if confirmed.

Study design

  • Retrospective cohort of 222 newly diagnosed patients with RA at an Australian center who were started on triple therapy at algorithm-determined doses to a daily maximum of 25 mg MTX, 3 g sulfasalazine, and 400 mg hydroxychloroquine.
  • Primary outcome was failure of triple therapy to maintain low disease activity (DAS28
  • Funding: Melrose Health.

Key results

  • 20% of cohort failed triple therapy by 1 year.
  • Mean baseline NLR was greater in those who failed triple therapy vs those who did not (3.7±2.8 vs 2.9±1.5; P=.02), but PLR was not.
  • Receiver operating curve generated a NLR cutoff of 2.70, with a sensitivity of 67% and specificity of 58%.
  • A baseline NLR 2.70 was an independent predictor of triple-negative therapy failure (OR, 2.65; P=.01).
  • PLR, erythrocyte sedimentation rate, C-reactive protein, and disease activity scale DAS-28 joint-ESR were not independent predictors of treatment failure.

Limitations

  • Monocentric, retrospective, observational design.