Rheumatoid factor as predictor of response to abatacept, rituximab and tocilizumab in rheumatoid arthritis: Systematic review and meta-analysis

Semin Arthritis Rheum. 2013 Aug;43(1):9-17. doi: 10.1016/j.semarthrit.2012.11.007. Epub 2013 Jan 2.


Objective: To identify if rheumatoid factor (RF) is predictor of response to rituximab (RTX), abatacept (ABT), and tocilizumab (TCZ) in rheumatoid arthritis (RA).

Methods: Systematic review and meta-analysis of clinical trials and observational studies based on a sensitive search. Meta-regression was used to explore causes of heterogeneity. Unpublished data of clinical trials provided by the authors were also included.

Results: The electronic search captured 3221 references and 422 meeting abstracts. By hand search, four additional articles were also identified. A total of 23 studies meet the purpose of the study and were included in the review. RF positivity at starting predicts better ACR20 [OR, 1.95 (1.24, 3.08)], ACR50 [OR, 5.38 (2.50, 11.60)] and EULAR response [OR, 3.52 (1.66, 7.45)] in 14 studies with RTX, and better ACR20 [OR, 1.51 (1.21, 1.90)] in 6 studies with TCZ. In 3 studies with ABT, no association was found between response and RF [OR 1.36 (0.97, 1.90)]. No asymmetries in the funnel plots or significant variables were found in the meta-regression.

Conclusion: In RA, RF positivity predicts better response to RTX and TCZ but not to ABT.

Keywords: Abatacept; Response; Rheumatoid factor; Rituximab; Tocilizumab.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Abatacept
  • Antibodies, Monoclonal, Humanized / therapeutic use*
  • Antibodies, Monoclonal, Murine-Derived / therapeutic use*
  • Antirheumatic Agents / therapeutic use*
  • Arthritis, Rheumatoid / blood
  • Arthritis, Rheumatoid / drug therapy*
  • Humans
  • Immunoconjugates / therapeutic use*
  • Rheumatoid Factor / blood*
  • Rituximab
  • Treatment Outcome


  • Antibodies, Monoclonal, Humanized
  • Antibodies, Monoclonal, Murine-Derived
  • Antirheumatic Agents
  • Immunoconjugates
  • Rituximab
  • Abatacept
  • Rheumatoid Factor
  • tocilizumab