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; =.019) and biologic-failure participants (HR, 0.76; 95% CI, 0.62-0.94; =.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.


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