Short-term adalimumab therapy improves endothelial function in patients with rheumatoid arthritis refractory to infliximab

Objective. Endothelial dysfunction has been found in patients with rheumatoid arthritis (RA). In this study we aimed to assess whether adalimumab, a fully human monoclonal antibody directed against TNF-alpha, was able to improve endothelial function in RA patients with long-standing disease refractory to infliximab. Methods. Eight RA patients (7 women; range: 24-74 years) were studied. They had been treated with the chimeric monoclonal anti-TNF-alpha antibody-infliximab for at least 1 year and were switched to adalimumab therapy because of loss of efficacy following periodical treatment with infliximab. Endothelial dependent (EDV) and independent vasodilatation (EIV) were measured by brachial ultrasonography. Patients were assessed prior to (day 0) and at day 2, and weeks 2 and 12 after the onset of adalimumab therapy. Results. Following adalimumab administration a rapid increase in the percentage (%) of EDV was found in all patients (mean +/- SD: 10.1 +/- 5.1% at day 2 compared to 5.8 +/- 4.1% at day 0). At weeks 2 and 12 the %EDV was also significantly increased compared to day 0. All patients showed decrease in the disease activity score 28 and C-reactive protein levels (P = 0.012). Moreover at week 12 the atherogenic index was reduced in all patients (P = 0.012). Conclusion. Our study confirms that short-term adalimumab therapy yields an active and positive affect on endothelial function in long-standing RA patients with severe disease. This observation emphasizes the potential role of the TNF-a blockade in the mechanisms implicated in the development of atherogenesis in RA.