Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratio as predictors of 12-week treatment response and drug persistence of anti-tumor necrosis factor-α agents in patients with rheumatoid arthritis: a retrospective chart review analysis

  • Han-Na Lee
  • Yun-Kyung Kim
  • Geun-Tae Kim
  • Eunyoung Ahn
  • Min Wook So
  • Dong Hyun Sohn
  • Seung-Geun LeeEmail author
Observational Research


Data are scarce regarding the association of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) with treatment response and persistence of anti-TNF-α agents in patients with rheumatoid arthritis (RA). Thus, we investigated whether baseline NLR and PLR could predict 12-week treatment response and long-term persistence of anti-TNF-α agents in RA patients. This is a retrospective chart review analysis of 82 women with RA who started anti-TNF-α agents as the first-line biologic therapy and 328 healthy age-matched women. RA patients were divided into high and low baseline NLR or PLR subgroups using the median split. European League against Rheumatism (EULAR) treatment response was evaluated at 12 weeks. RA patients had significantly higher NLR and PLR than controls. High baseline NLR and PLR groups showed higher 12-week EULAR non-response rate than low NLR (30% vs 7.1%, p = 0.01) and PLR groups (27.5% vs 9.5%, p = 0.047), respectively. After adjusting for confounding factors, high baseline NLR (OR 5.57, p = 0.014) and PLR (OR 4.24, p = 0.04) were significantly associated with a higher risk of EULAR non-response at 12 weeks. During the study period, 47 (57.3%) RA patients (lack of efficacy: n = 31; adverse events: n = 16) discontinued anti-TNF-α agents. High baseline NLR was associated with an increased risk of anti-TNF-α agent withdrawal due to lack of efficacy (HR 2.12, p = 0.045). Our data suggest that baseline NLR and PLR are useful markers for predicting the treatment outcome of anti-TNF-α agents in RA patients.


Rheumatoid arthritis Tumor necrosis factor-alpha Blood cells Treatment outcome Biomarkers 



We specially thank the late Professor Sung-Il Kim who devoted himself to education, research, and patient care in Division of Rheumatology, Department of Internal Medicine, Pusan National University School of Medicine (1963–2011).

Author contributions

HNL: study design, data collection and analysis and writing manuscript, YKK: data interpretation, GTK: data interpretation and revision of manuscript, MWS: data interpretation and revision of manuscript, EA: data interpretation, DHS: data interpretation and revision of manuscript, SGL: study design, data analysis and interpretation, writing manuscript and coordination of entire study.


This work was supported by a clinical research Grant from Pusan National University Hospital in 2019.

Compliance with ethical standards

Conflict of interest

The authors have declared no conflicts of interest.

Ethical standards

This study protocol was approved by the by the Research and Ethical Review Board of the Pusan National University Hospital, which waived written informed consent due to retrospective study design (IRB no. 1809-010-071).

Supplementary material

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Supplementary material 1 (DOCX 13 KB)
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Supplementary material 2 (DOCX 13 KB)
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Supplementary figure 1. Persistence with anti-tumor necrosis factor-alpha agents in patients with rheumatoid arthritis II (TIF 1306 KB)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Rheumatology, Department of Internal MedicinePusan National University School of Medicine, Pusan National University HospitalBusanSouth Korea
  2. 2.Biomedical Research InstitutePusan National University HospitalBusanSouth Korea
  3. 3.Division of Rheumatology, Department of Internal Medicine, KosinUniversity College of MedicineBusanSouth Korea
  4. 4.Division of Rheumatology, Department of Internal MedicinePusan National University Yangsan HospitalYangsanSouth Korea
  5. 5.Department of Microbiology and ImmunologyPusan National University School of MedicineYangsanSouth Korea

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