Article Text

PDF
SAT0379 Effects of Abatacept on Synovitis as Assessed by Magnetic Resonance Imaging (MRI) in Psoriatic Arthritis - Preliminary Analysis from A Single Centre, Placebo-Controlled, Crossover Study
  1. A. Szentpetery1,
  2. E. Heffernan2,
  3. M. Haroon1,
  4. P. Gallagher1,
  5. A.-M. Baker1,
  6. M. Cooney1,
  7. O. FitzGerald1
  1. 1Department of Rheumatology
  2. 2Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland

Abstract

Background Abatacept, a soluble, fully human fusion protein which selectively inhibits T-cell activation via competitive binding to CD80/CD86, decreases serum levels of cytokines and inflammatory proteins implicated in the pathogenesis of psoriatic arthritis (PsA). It has been proposed that 10 mg/kg of abatacept, the approved dose for rheumatoid arthritis may be an effective treatment choice for PsA. [1]

Objectives (1) To study both skin and joint-related clinical outcomes prior to and 6 months after introducing abatacept treatment in PsA; (2) To investigate MRI changes of an inflamed knee joint over time in PsA patients on abatacept.

Methods 15 biological treatment-naïve PsA patients fulfilling the CASPAR criteria with active disease for ≥3 months (≥3 swollen and ≥3 tender joints) with clinical synovitis of a knee and the presence of a psoriatic skin lesion were enrolled in the study. Patients were randomised to receive abatacept 3mg/kg or placebo infusion on day 1, 15 and 29; thereafter abatacept 10mg/kg was administered to all patients every 28 days for 5 months. A stable dose of methotrexate (7.5-25 mgs/week) for >3 months prior to randomization was the only concomitant DMARD permitted. Gad-enhanced MRI of the same involved knee was performed at baseline, 2 and 6 months and scored using the PsAMRIS method by one consultant radiologist. For the semi-quantitative method each knee was divided into 4 anatomical regions; medial (MED) and lateral (LAT) parapateller recesses, intercondylar notch (ICN) and suprapatellar pouch (SPP). A synovitis score ranging from 0 to 3 was assigned to each region and then added to give a total MR synovitis score (MRS) ranging from 0 to 12.

Results At the time of the analysis, the study is still blinded and so the results discussed are the overall results from 14 of the 15 patients. Patients (8 female/6 male) mean age was 44.6 (±15.2) years. Four patients were on methotrexate with the remainder not receiving any DMARDs during the study. At baseline patients' mean DAS28-ESR was 4.9 (±1) and DAS28-CRP 4.8 (±0.8). Median PASI, HAQ, PsAQol and DLQI were 3.6 (0-9.6), 1 (0-2.125), 10.5 (1-17) and 2.5 (0-27) respectively. Mean synovitis scores at MED, LAT, ICN and SPP regions were 2.07 (±0.9), 2.21 (±0.9), 1.4 (±0.8) and 1.85 (±1) respectively at baseline; mean MRS was 7.6 (±3.4). As per EULAR criteria 87.5% of the patients responded to the treatment at 6 months; 75% judged a good responder. 68 tender and 66 swollen joint counts, duration of morning stiffness, global health score, DAS28-ESR, DAS28-CRP, HAQ and PsAQol reduced significantly at 6 months compared to baseline. While there was no significant difference compared to baseline in the 4 anatomical region scores, the median MRS decreased over the study period and was significantly lower at 6 months compared to baseline (p=0.016).

Conclusions These interim results show that 6 months of abatacept treatment reduced synovitis scores as assessed by MRI. Our results mirror the clinical improvements observed and support published data suggesting that 10 mg/kg of abatacept is a potent treatment option in PsA.

References

  1. Mease P et. al. Abatacept in the Treatment of Patients With Psoriatic Arthritis. Arthritis Rheum. 2011 Apr;63(4):939-48.

Acknowledgements This study received drug and financial support from Bristol Myers Squibb.

Disclosure of Interest A. Szentpetery: None declared, E. Heffernan: None declared, M. Haroon: None declared, P. Gallagher: None declared, A.-M. Baker: None declared, M. Cooney: None declared, O. FitzGerald Grant/research support: Pfizer, Abbott, BMS, MSD, Roche, UCB, Consultant for: Pfizer, Abbott, BMS, MSD, Janssen, Roche, Speakers bureau: Pfizer, Abbott, Janssen, Roche, UCB

DOI 10.1136/annrheumdis-2014-eular.5531

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.