Abatacept and certolizumab pegol effective first-line treatments for early RA: BMJ

Abatacept and certolizumab pegol appear to be particularly promising choices for achieving remission in early rheumatoid arthritis (RA) patients the as optimal first-line therapy. The findings were published in Annals of the Rheumatic Diseases.

Patients with treatment-naïve early RA, experiencing moderate to severe disease activity, were enrolled in this randomized 1:1:1:1 trial. They were assigned to one of four treatment groups: methotrexate combined with (1) active conventional therapy, including oral prednisolone (tapered quickly and discontinued at week 36) or sulfasalazine, hydroxychloroquine, and intra-articular glucocorticoid injections in swollen joints; (2) certolizumab pegol; (3) abatacept; or (4) tocilizumab.

The study's co-primary endpoints were assessed at week 48 and included Clinical Disease Activity Index (CDAI) remission (CDAI ≤2.8) and changes in radiographic van der Heijde-modified Sharp Score. These results were adjusted for factors like sex, anticitrullinated protein antibody status, and country, and the significance level was set at 0.025 to account for multiple testing.

The findings revealed that adjusted CDAI remission rates at week 48 were impressive across the board: abatacept (59.3%), certolizumab (52.3%), tocilizumab (51.9%), and active conventional therapy (39.2%). When compared to active conventional therapy, abatacept showed a remarkable increase in CDAI remission rates (+20.1%), while certolizumab demonstrated a notable improvement (+13.1%). Tocilizumab also performed well, with a +12.7% difference.

Key secondary clinical outcomes consistently favored the biological treatment groups, highlighting their potential superiority. Remarkably, radiographic progression remained low across all treatment options, with no significant differences noted between them.

In terms of safety, the proportions of patients experiencing serious adverse events were as follows: abatacept (8.3%), certolizumab (12.4%), tocilizumab (9.2%), and active conventional therapy (10.7%).

These findings suggest that abatacept and certolizumab pegol hold promise as more effective first-line treatments for early RA compared to active conventional therapy. While tocilizumab didn't show as significant a difference, its performance remains noteworthy. Furthermore, the low radiographic progression observed across all groups is encouraging news for patients dealing with this debilitating condition. 

Source:

Østergaard, M., van Vollenhoven, R. F., Rudin, A., Hetland, M. L., Heiberg, M. S.,Gudbjornsson, B., Ørnbjerg, L. M., Bøyesen, P., Lend, K., Hørslev-Petersen, K., Uhlig, T., Sokka, T., Krabbe, S., Glinatsi, D., … Lampa, J. (2023). Certolizumab pegol, abatacept, tocilizumab or active conventional treatment in early rheumatoid arthritis: 48-week clinical and radiographic results of the investigator-initiated randomised controlled NORD-STAR trial. In Annals of the Rheumatic Diseases (Vol. 82, Issue 10, pp. 1286–1295). BMJ. https://doi.org/10.1136/ard-2023-224116