Rheumatoid Arthritis

Earlier Abatacept Initiation May Increase Retention Rates in RA

Avatar photoHannah Dellabella
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Although there is no cure for arthritis, early diagnosis and appropriate management is important. Early use of disease-modifying drugs can affect the course of rheumatoid arthritis. Teach patients to describe any pain using specific words such as aching, searing, throbbing and stabbing.
Although there is no cure for arthritis, early diagnosis and appropriate management is important. Early use of disease-modifying drugs can affect the course of rheumatoid arthritis. Teach patients to describe any pain using specific words such as aching, searing, throbbing and stabbing.
Researchers found that in patients with rheumatoid arthritis, seropositivity for rheumatoid factor and anti-cyclic citrullinated peptide was indicative for abatacept retention.

For patients with rheumatoid arthritis (RA), initiating abatacept as an earlier line of therapy may lead to higher 2-year retention rates, according to results published in Clinical Rheumatology.

The results also indicated that rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) double positivity predicted increased retention.

The study included participants with moderate-to-severe RA who initiated intravenous abatacept. The researchers used Kaplan-Meier analyses in biologic-naïve and biologic-failure participants to estimate crude abatacept retention rates. They used a Cox proportional hazards multivariable models to evaluate clinically-relevant risk factors and significant prognostic factors for retention.

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Out of 2364 enrolled participants, 2350 were able to be evaluated. Of these, 28.6% (n=673) were biologic naive and 71.4% (n=1677) had prior biologic failure. Of those who had prior biologic failure, 43.4% (n=728) had used 1 biologic and 56.6% (n=949) had used ≥2.

At 2 years of follow-up, the total abatacept retention rate was 47.9%; 54.5% for biologic-naive participants and 45.2% for biologic-failure participants (P<.001). For participants with 1 biologic failure, the retention rate was 50.2% compared with 41.3% for those with ≥2 failures (P<.001).

The researchers found that the main reasons for abatacept discontinuation were lack of efficacy and safety.

After analysis, the results indicated that RF and anti-CCP double positivity were predictive of higher retention rates in both biologic-naive (hazard ratio [HR], 0.71; 95% CI, 0.53-0.96; P =.019) and biologic-failure participants (HR, 0.76; 95% CI, 0.62-0.94; P =.035) compared with negativity.

“These findings have the potential to inform the development of an individualized treatment plan for the optimal management of patients with moderate-to-severe RA,” the researchers wrote.

Reference

Alten R, Mariette X, Lorenz H, et al. Predictors of abatacept retention over 2 years in patients with rheumatoid arthritis: results from the real-world ACTION study [published online February 21, 2019]. Clin Rheumatol. doi: 10.1007/s10067-019-04449-w

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