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A retrospective study using data from a Japanese registry (the ANSWER cohort) revealed that there was differential efficacy of TNFis based on the presence/absence of the Fc region.† Treatment with the Fc-free TNFi resulted in significantly lower Disease Activity Score 28-erythrocyte sedimentation rate (DAS28-ESR) scores in patients with high RF levels (>166 IU/mL) at 12 months vs patients treated with other Fc-containing TNFis.11

ANSWER cohort study
ANSWER cohort study

†TNFis with Fc: adalimumab, etanercept, infliximab, golimumab; TNFi without Fc: certolizumab.

Certolizumab=certolizumab pegol; dDAS28-ESR=change in Disease Activity Score 28-erythrocyte sedimentation rate; Fc=fragment crystallizable; IU=international units; Q=quartile; RA=rheumatoid arthritis; RF=rheumatoid factor; TNFi=tumor necrosis factor inhibitor.

Figures adapted from Nakayama Y, et al. Differential efficacy of TNF inhibitors with or without the immunoglobulin fragment crystallizable (Fc) portion in rheumatoid arthritis: The ANSWER cohort study. Rheumatol Int. 2022; Jul;42(7):1227-1234. Used with permission from Sprinter Nature