Abatacept Improves Subclinical Arthritis in Individuals at High Risk for Rheumatoid Arthritis

Researchers the effect of abatacept vs placebo on subclinical arthritis in patients with ACPA and MRI signs of inflammation, at high risk for RA.

The following article is a part of conference coverage from the American College of Rheumatology (ACR) Convergence 2021, being held virtually from November 3 to 10, 2021. The team at Rheumatology Advisor will be reporting on the latest news and research conducted by leading experts in rheumatology. Check back for more from the ACR Convergence 2021.


Use of abatacept significantly improves subclinical arthritis among individuals at high risk of developing rheumatoid arthritis (RA), according to study results presented at the American College of Rheumatology (ACR) Convergence 2021, held virtually from November 3 to 10, 2021.

Abatacept interrupts the activation of T cells and has a favorable safety profile in the treatment of RA; therefore, the researchers of the current multicenter, randomized, double-blinded, placebo-controlled ARIAA study sought to evaluate whether abatacept therapy compared with placebo reversed subclinical arthritis in individuals with anticitrullinated protein antibody (ACPA) and magnetic resonance imaging (MRI) signs of inflammation at risk for RA.

The primary study endpoint was improvement in at least 1 of the MRI parameters of inflammation (ie, any change from baseline of >0 that assesses synovitis, tenosynovitis, and osteitis), based on the Rheumatoid Arthritis Magnetic Resonance Imaging Score (RAMRIS).

The study included a 6-month treatment phase with either abatacept 125 mg administered subcutaneously or placebo weekly, then a 12-month follow-up period with no treatment. The primary analysis included the intent-to-treat (ITT) population, with missing values rated as failure to respond to treatment.

From November 2014 through December 2019, a total of 139 participants were included in the ARIAA study from 14 sites (11 in Germany, 2 in Spain, and 1 in Czech Republic). Among these individuals, 100 were randomly assigned to receive either abatacept or placebo. Two participants were excluded from the ITT population; the safety and efficacy of abatacept were evaluated in a total of 98 participants.

The primary endpoint of the study was attained, with 61% of individuals in the abatacept group demonstrating improvement in at least 1 of the MRI parameters, compared with only 31% in the placebo group (P =.0043).

In addition, arthritis developed in 34.7% (n=17/49) of participants in the placebo group compared with 8.2% (n=4/49) of those in the abatacept group (P =.0025). Among 12 serious adverse events that were reported, only 1 (pneumonia) was considered to have a causal relationship to the study drug.

The researchers concluded, “These data show that abatacept significantly improves subclinical arthritis in [individuals] at high risk to develop RA. In addition, the data also support the concept that early intervention may prevent or at least delay the development of RA.”

Disclosure: Some of the study authors have declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


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Rech J, Ostergaard M, Tascilar K, et al. Abatacept reverses subclinical arthritis in patients with high-risk to develop rheumatoid arthritis -results from the randomized, placebo-controlled ARIAA study in RA-at risk patients. Presented at: ACR Convergence 2021; November 3-10, 2021. Abstract 0455.