Background and objectives Abatacept (ABA) is a selective co-stimulation modulator. ABA is widely used in treatment of RA. There isn’t enough data about the effectiveness of ABA at different stages of RA.
Objectives To compare effect of ABA in patients (pts) with early (ERA) and long-standing (LS) RA.
Materials and methods Eighty patients with early (less than three years duration, 51%) and LS (more than three years duration, 49%) RA and an inadequate response to synthetic DMARDs or biologics (adalimumab, rituximab, tocilizumab) were enrolled in the study. Most of them were women, age 49 ± 13 years, with a high disease activity (DAS28=5,28 ± 1,1), RF-positive (75.7%) and ACPA-positive (75%). Disease activity was assessed by DAS28. Results were assessed every 12 weeks according to EULAR criteria.
Results Before treatment in patients with early RA DAS28 was 5.26 ± 0.89, with long-standing RA - 5,3 ± 1,3. After 3 months of therapy good and moderate response by EULAR criteria was achieved in 82.2% in the group of ERA and in 67.5% of patients with LS RA (p < 0.05). There was no significant difference in achieving good EULAR response between two groups after 3 months (26.47% - ERA; 25.7% - LS RA) and 6 months of therapy (31.9% - ERA; 35.2% - LS RA). The number of non-responders in pts with LS RA was significantly higher both after 3 months and 6 months (32.35% and 25.3%) as compared to pts with ERA (17.6% and 17.02% respectively). 25 adverse events (AE) in 19 (23%) pts were registered. The most frequent AE were upper respiratory tract infections - 8 pts. One pt has herpes zoster and one, abscess of the right thumb.
Conclusion Abatacept has shown significant improvement in reduction of disease activity in pts with an inadequate response to previous therapy. There was no significant difference in achieving good EULAR response between pts with early and LS RA. There were more patients with an inadequate response to ABA in the LS RA group. ABA was well tolerated, AE were registered only in 23% of patients. ABA is an effective drug with a good safety profile. ABA has found its niche in the treatment of both LS and ERA.