Abatacept Effective for Early Rheumatoid Arthritis

Treatment with abatacept can help patients with early rheumatoid arthritis maintain remission even after tapering or withdrawing all other therapy, according to research published from Belgium.

For early rheumatoid arthritis (RA) patients with poor prognoses, abatacept may be able to taper their dosages, according to research published in the Annals of Rheumatic Diseases.

Researchers from the University Hospitals Leuven in Belgium TK in order to assess maintenance of response while reducing intravenous abatacept doses in patients with early RA. The 108 patients involved in the study achieved disease activity scores (DAS) of 28 (erythrocyte sedimentation rate, ESR) <2.6. The patients were followed up with after a period of 1 year to measure the time to disease relapse, which the researchers defined as time to additional disease modifying anti rheumatic drugs (DMARDs), ≥2 courses high-dose steroids, return to open-label abatacept ∼10 mg/kg, or DAS28 (C reactive protein) ≥3.2 at 2 consecutive visits).

The patients were randomized into 2 groups: 58 participants received abatacept ~10 mg/ kg and 50 participants received abatacept ~5 mg/ kg. There were 3 and 5 patients who discontinued from each respective group, though 4 per group returned to open label abatacept. Relapse over time was similar in both groups, as was the proportion of patients relapsing in both groups (31 percent versus 34 percent in the ~10 mg/ kg and ~5 mg/kg, respectively).

Few patients required additional DMARDs or return to open label ~10 mg/ kg abatacept. Most patients maintain remission following biological dose reduction, the study found.

“Considering the potential to alter the course of disease in some patients with early RA, along with the safety and health economic benefits in avoiding unnecessary drug exposure, timely induction of biological agents (preferably in combination with methotrexate (MTX)), followed by dose reduction, might be a therapeutic option in patients with early RA who have achieved DAS 28 <2.6, and deserves further investigation,” the authors wrote.

The researchers also determined the risk for immunogenicity was not substantially different between the groups.

“Lower drug exposure in the ~5 mg/ kg group did not appear to increase the risk of immunogenicity,” the authors commented. “In general, the number and type of safety events were as expected based on previous reports, and did not differ between groups.”

The investigators noted the results should be interpreted with some caution, especially due to the fact that the patients involved had achieved remission after 2 years’ treatment with abatacept ~10 mg/ kg. In addition to its small sample size, the study the development of the study took place before industrial guidelines were standardized.