EXTENDED REPORTS

Abatacept inhibits progression of structural damage in rheumatoid arthritis: results from the long-term extension of the AIM trial

H K Genant^1,2, C G Peterfy², R Westhovens³, J-C Becker⁴, R Aranda⁴, G Vratsanos⁴, J Teng⁴, J M Kremer⁵

¹ University of California, San Francisco, San Francisco, California, USA
² Synarc, Inc., San Francisco, California, USA
³ UZ Gasthuisberg, Leuven, Belgium
⁴ Global Clinical Research, Immunology, Bristol-Myers Squibb, Princeton, New Jersey, USA
⁵ Albany Medical College and The Center for Rheumatology, Albany, New York, USA

Harry K Genant, University of California, San Francisco, San Francisco, CA, USA; harry.genant{at}ucsf.edu

Objective: Assess the effect of abatacept on progression of structural damage over 2 years in patients with rheumatoid arthritis who had an inadequate response to methotrexate.

Methods: 539 patients entered an open-label extension of the AIM (Abatacept in Inadequate responders to Methotrexate) trial and received abatacept. Radiographic assessment of the hands and feet was performed at baseline, year 1 and year 2. At year 2, each patient’s radiographs were scored for progression blinded to sequence and treatment allocation.

Results: In patients treated with abatacept for 2 years, greater reduction in progression of structural damage was observed in year 2 than in year 1. The mean change in total Genant-modified Sharp scores was reduced from 1.07 units in year 1 to 0.46 units in year 2. Similar reductions were observed in erosion and joint space narrowing scores. Following 2 years of treatment with abatacept, 50% of patients had no progression of structural damage as defined by a change in the total score of 0 compared with baseline. 56% of patients treated with abatacept had no progression during the first year compared with 45% of patients treated with placebo. In their second year of treatment with abatacept, more patients had no progression than in the first year (66% vs 56%).

Conclusions: Abatacept has a sustained effect that inhibits progression of structural damage. Furthermore, the mean change in radiographic progression in patients treated with abatacept for 2 years was significantly lower in year 2 versus year 1, suggesting that abatacept may have an increasing disease-modifying effect on structural damage over time.

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