Background Abatacept is a biologic therapy which suppresses T-cell activation via co-stimulation blockade in rheumatoid arthritis (RA) patients. It became part of our biologic algorithm shortly after initial limited NICE approval in August 2010. In April 2013, NICE widened its recommendation of abatacept in RA patients who have failed to respond adequately to 2 disease-modifying anti-rheumatic drugs (DMARDs) including methotrexate .
Objectives In this study we share our experience of abatacept in patients with rheumatoid arthritis (RA) in routine clinical practice from a subregional centre in UK covering a population of 500,000.
Methods This was a retrospective analysis of 84 patients who received abatacept therapy from November 2010 to January 2014. Data collected included baseline demographics, number of previous synthetic and biologic DMARDs, change in DAS28 at 3 and 6 months. Response was defined as DAS28 reduction of greater than 1.2.
Results 84 patients with RA were commenced on abatacept therapy over 39 months since Nov 2010. The mean age of the patients was 62 years and 74% of them were female. The average number of prior synthetic DMARDs was 2.8 and biologic DMARDs 2.1. Only 2 patients were biologic- naïve before abatacept. 75 patients had received anti-TNF therapy (adalimumab, certolizumab pegol, etanercept, golimumab, infliximab), 40 had received rituximab and 7 tocilizumab.
The baseline DAS28 was 5.8 and mean DAS reduction at 3 and 6 months was 1.6 (n=41) and 2.0 (n=37) respectively. 25 out of 41 (61%) patients responded at 3 months and this increased to 76% at 6 months (28/37). 14% (5/37) achieved remission at 6 months. 11 patients stopped abatacept therapy, 5 were intolerant of which 3 had infusion reactions, 1 patient had lack of efficacy and 2 loss of efficacy (between 3 and 6 months), 1 patient refused further infusions and 2 patients moved out of area. In a subgroup, the mean DAS reduction at 6 months in seropositive (Rheumatoid Factor or Anti-CCP antibody positive n=14) and seronegative patients (n=16) were 2.54 and 1.88 respectively.
Conclusions Our experience shows that abatacept is safe, well tolerated and effective in RA patients with inadequate response to previous synthetic and biologic DMARDs in routine clinical practice. The improvement in DAS28 at 3 months was sustained at 6 months. The numbers are small to draw any conclusion about better response in seropositive RA patients.
NICE recommends wider use of abatacept for treating rheumatoid arthritis (Guidance TA195) August 2010
NICE technology appraisal guidance: Abatacept for treating rheumatoid arthritis after the failure of conventional disease-modifying anti-rheumatic drugs (Guidance TA280 rapid review of TA234) April 2013
Acknowledgements We would like to thank all members of the Rheumatology team at Cannock Hospital and the patients who participated.
Disclosure of Interest None declared