Abatacept Boosts Chances of Remission in Relapsing Granulomatosis

Langford CA, Monach PA, Specks U, et al., An open-label trial of abatacept (CTLA4-IG) in non-severe relapsing granulomatosis with polyangiitis (Wegener's). Ann Rheum Dis. (2013) Dec 9. doi: 10.1136/annrheumdis-2013-204164. [Epub ahead of print]

A small multicenter study shows that intravenous abatacept (Orencia) can produce a high rate of remission in patients with in non-severe relapsing Wegener’s granulomatosis with polyangiitis (GPA).

In the open-label safety and efficacy study of IV abatacept (ABA), most patients had disease improvement and 80% (n=16) achieved remission according to the Birmingham Vasculitis Activity Score for Wegener’s Granulomatosis (remission, BVAS/WG=0) within a couple of months.

A total of 20 patients (median age 45) with non-severe relapsing GPA were enrolled over 28 months. A majority (70%) remained in the study until the last patient was enrolled (common closing).

They were given varied doses of ABA 10 mg/kg (500 mg for <60 kg, 750 mg for 60–100 kg, and 1000 mg for >100 kg) on days 1, 15, 29 and every 4 weeks until common closing. Study patients continued on previous medications, and a substantial percentage of those taking prednisone were able to discontinue after a taper at two months.

Sixteen patients remained in remission for 14 months and three relapsed within 6.7 months. Nine patients experienced serious adverse events, mostly infections.

Although the small numbers were a limitation, the researchers conclude that ABA merits further investigation as a treatment option, since relapse is common in GPA and is associated with substantial damage and morbidity.