Annals of the Rheumatic Diseases 2008;67:1084-1089
EXTENDED REPORTS
Abatacept inhibits progression of structural damage in rheumatoid arthritis: results from the long-term extension of the AIM trial
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 patients 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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