Abatacept has better clinical response than TNFi in ACPA-positive RA patients: study

Written By : Dr Supreeth D R |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2022-12-06T05:00:57+05:30 | Updated On 6 Dec 2022 12:05 PM IST

Patients with rheumatoid arthritis (RA) who are anti-citrullinated protein antibody (ACPA)-positive have been shown to respond better to abatacept and rituximab than patients who are ACPA negative. Yet, the evidence regarding comparative efficacy of biologic agents stratified by patient's ACPA serostatus is very limited in Asian patients with RA. Hence, Min Jung Kim et al conducted a study to compare the efficacy of abatacept and tumor necrosis factor inhibitor (TNFi) in patients with ACPA- positive rheumatoid arthritis (RA) and identify those who benefit most from abatacept over TNFi.

This observational study identified RA patients who were ACPA-positive and initiated abatacept or TNFi from the Korean College of Rheumatology Biologics and Targeted therapy registry. Propensity score (PS) matching was performed to balance baseline confounding in abatacept- or TNFi-treated patients. The major endpoints were changes in Clinical Disease Activity Index (CDAI) and achievement of CDAI remission/low disease activity after 1 year of treatment. Subgroup analysis was mainly performed stratified by prior biologics use.

Key findings of the study were:

• A total of 291 PS-matched, ACPA-positive RA patients who initiated abatacept (n = 97) and TNFi (n = 194) were included.

• From baseline CDAI scores of 26.52 in the abatacept group and 26.38 in the TNFi group, the mean changes after 1 year were - 16.78 and - 13.61, respectively (difference - 3.17, p = 0.020).

• The proportion of patients achieving CDAI remission/low disease activity was 68.0% with abatacept and 52.6% with TNFi (p = 0.013).

• In the subgroup analysis, patients that were biologics-naive had better improvement in CDAI after treatment with abatacept than TNFi (difference - 3.35, p = 0.021).

The authors concluded that - This study, based on data from this nationwide biologic registry, suggests that abatacept may show a significant improvement in clinical outcomes compared to TNFi in patients with established ACPA-positive RA. Abatacept may be particularly beneficial over TNFi in patients with ACPA-positive RA who are bDMARD-naive or have an ACPA titer of 100 U/ml or less. These findings suggest that stratification of patients by ACPA serostatus, along with disease duration and previous biologic treatment, is important in predicting treatment response of abatacept, thereby improving the clinical response by selecting a suitable biological treatment option for the right patient.

MBBS, Dip. Ortho, DNB ortho, MNAMS

Dr Supreeth D R (MBBS, Dip. Ortho, DNB ortho, MNAMS) is a practicing orthopedician with interest in medical research and publishing articles. He completed MBBS from mysore medical college, dip ortho from Trivandrum medical college and sec. DNB from Manipal Hospital, Bengaluru. He has expirence of 7years in the field of orthopedics. He has presented scientific papers & posters in various state, national and international conferences. His interest in writing articles lead the way to join medical dialogues. He can be contacted at editorial@medicaldialogues.in.

Dr. Kamal Kant Kohli

Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751