Background Abatacept is approved for use in patients with rheumatoid arthritis (RA) with or without methotrexate (MTX). However, it is not clarified whether abatacept inhibits the progression of joint damage without concomitant MTX.
Objectives The purpose of this study was to clarify the inhibitory effect of abatacept on large joint damage and its clinical efficacy in RA patients with or without concomitant MTX in routine clinical practice.
Methods We developed FIT-RA (Fukui, Ishikawa, Toyama-rheumatoid arthritis) registry, and a retrospective multicenter study was conducted using this registry. Patients with RA who underwent abatacept treatment for 52 weeks were analyzed. Disease activity was assessed using DAS28-CRP. Radiographs of hand, foot, shoulder, elbow, hip, knee and ankle joints were obtained at baseline and week 52. Joint damage scores were assessed by two independent readers using the van der Heijde modified total Sharp score (mTSS). The change of mTSS between baseline and at 52 weeks was evaluated as ΔmTSS. Large joint damage was assessed by two independent readers using the ARASHI scoring system1.
Results Forty eight chronologically consecutive patients in the hospitals (4 males, 44 women, mean age of 62.8 years old, mean disease duration of 12.0 years, mean DAS28-CRP of 4.0, rate of MTX use of 56.3%) with active RA who started abatacept therapy were analyzed. All patients fulfilled the ACR 1987 revised criteria. Five patients were withdrawn during 1 year due to insufficient efficacy. The retention rates at 1 year of patients with or without concomitant MTX were 88.9% and 90.5%, respectively. At week 52, 37% and 33.3% of patients with or without concomitant MTX achieved clinical remission, respectively. There was no significant difference in achievement of remission by the concomitant use of MTX. Radiographic analysis of mTSS was performed for 43 patients who completed 52-week abatacept treatment. Among 43 patients, assessment of large joint damage was performed for 42 patients who had radiography of large joints at baseline and at week 52. A total of 377 large joints in 42 patients were analyzed. The ΔmTSS decreased significantly from 9.44 at baseline to 0.86 at week 52. Rates of the structural remission [ΔmTSS: less than 1 point] was achieved in patients with and without concomitant MTX were 58.3% and 68.4%, respectively. There was no significant difference in achievement of radiographic remission of two groups. The rates of radiographic remission [ARASHI change score: less than 1 point] were 94.9%, 83.1%, 94.9%, 79.7% and 91.8% in shoulder, elbow, hip, knee and ankle joints, respectively. The rates of radiographic remission of shoulder joint with and without concomitant MTX were 95.2% and 94.6%, respectively. There was no significant difference in achievement of radiographic remission of two groups. In elbow, hip, knee and ankle joints, there was also no significant difference in achievement of radiographic remission between with and without MTX. Thus, it was demonstrated that the radiographic changes were not significantly affected by the concomitant use of MTX.
Conclusions Abatacept showed good clinical and radiographic effects for RA patients with or without concomitant MTX in routine clinical practice.
Atsushi Kaneko, et al. Mod Rheumatol 2013(23):1053-1062.
Acknowledgements We thank members of FIT-RA group for their kind corporations and suggestions.
Disclosure of Interest None declared
Statistics from Altmetric.com
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.