Figure 1.
In the first stage, 8 patients were randomized 3∶1 to receive 90 µg TNF-K or placebo, in the second, 16 patients were randomized 3∶1 to receive 180 µg TNF-K or placebo, and in the third, 17 patients were randomized 3∶1 to receive 360 µg TNF-K or placebo. In each stage, patients were also randomized 1∶1 to receive 2 doses (day 0, 28) or 3 doses (day 0, 7, 28) (arrows). For stages 1 and 2, after 3 patients had been enrolled and no safety issues had been reported for at least 7 days, enrolment in the subsequent stage started in parallel. One patient randomized to receive 3 doses of 360 µg TNF-K withdrew consent prior to treatment. The principal analysis portion of the study continued up to day 84, and the follow-up portion continued up to month 12.
Table 1.
Demographics of treated patients at baseline (day 0).
Figure 2.
Humoral immune response to TNF.
Patients were treated with 2 doses (days 0 and 28) or 3 doses (days 0, 7, and 28) of placebo or 90, 180, or 360 µg TNF-K. Anti-TNF antibody titers were determined by enzyme-linked immunosorbent assay. (A) GMTs. (B) Percent of patients in each treatment group with detectable anti-TNF antibodies (titer ≥200) up to month 3 (at study day 38, 56, or 84), at month 6, at month 12, or at any time up to month 12 (i.e., antibody responders).
Figure 3.
Peripheral blood mononuclear cells were collected on days 0 and 56 and treated in vitro with medium (control) or with 10 µg/mL TNF-K, TNF, or KLH. Lymphoproliferation was assessed after 72 h by 3H-thymidine incorporation. Shown is the stimulation index (fold-increase in lymphoproliferation vs. control) for cells from patients treated with placebo (n = 6) or TNF-K (n = 10).
Table 2.
Adverse reactions solicited post injection.
Figure 4.
Difference from baseline for clinical assessments in anti-TNF antibody responders and non-responders.
Post-hoc analyses: Mean changes in clinical assessments from baseline are shown at months 3, 6, and 12 for antibody responders (detectable anti-TNF antibodies at any time; gray bars) and for non-responders (white bars). (A) DAS28-CRP. (B) CRP. (C) Tender joints count. (D) Swollen joints count. (E) Patient’s global activity score. (F) Physician’s global activity score. (G) Patient assessment of pain. (H) Change in HAQ disability/function score. Error bars indicate standard error of the mean. P-values were determined by Wilcoxon rank-sum test. NS, not significant (p≥0.05). In responders, n = 19 at month 3, 16 at months 6 and 12 except at month 3 for Physician GAS n = 18 and for CRP n = 20. In non-responders, n = 17 at month 3 and 15 at months 6 and 12 except at month 6 n = 14 for CRP and DAS 28 score.