Background Abatacept (ABT) and tacrolimus (TAC) are similar at the point that both drugs block the T cell activation. ABT blocks co-stimulatory signaling from CD80/86 on the surface of antigen-presenting cell. TAC blocks the calcineurin activity in T cells. The each effectiveness of ABT and TAC respectively for the treatment of rheumatoid arthritis (RA) is apparent, however, the efficacy and safety at concomitant use of ABT and TAC was not unclear and there are few reports [1,2].
Objectives The objective of this study is comparison between ABT therapy for RA patients with and without TAC.
Methods Forty eight RA patients were included in this observational retrospective study, who were undertaken intravenous ABT therapy at Osaka Rosai Hospital after February 2011 and could be observed over 52 weeks. Patient background, efficacy, and safety were examined.
Results Mean age was 67.4 years, disease duration was 10.8 years. Concomitant use of methotrexate was 58%, of prednisolone was 56% and prior biologics use was 48%. Concomitant use of TAC was 31%. Mean tacrolimus dose was 2.0g (1.0–3.0). The retension rate of ABT at 52 weeks was 80.8%. DAS28CRP was decreased significantly at 4 weeks (-16.5% from baseline, p<0.001), and gradually decreased until 24 weeks (-37.3%, p<0.001) and maintained until 52weeks (-39.3%, p<0.001) by Wilcoxon signed rank test. Patient background between ABT + TAC group (n=15) vs ABT group (n=33) were not significantly different (age, sex, disease duration, stage, class, concomitant use of prednisolone, MTX, prior biologics, baseline DAS28CRP, positivity of RF, ACPA) by chi-square test and Mann-Whitney U test. DAS28CRP of ABT + TAC group decreased significantly greater than ABT group at 16 weeks (-42.9% vs -30.3%, p=0.048), maintained until 52 weeks (-50.1% vs -34.5%, p=0.017) by Mann-Whitney U test. Adverse event between ABT + TAC and ABT group was not different. Predictive factor that achieve the low disease activity at 52weeks were Steinbrocker class1/2 (p=0.047), concomitant use of TAC (p=0.043) and DAS<3.3 at 12 weeks (p=0.005) by multivariate logistic regression analysis.
Conclusions ABT therapy concomitant with TAC has the possibility to show higher effectiveness for RA patients than ABT therapy without TAC.
Fujibayashi T. Mod Rheumatol 25: 825–30, 2015
Takahashi N. Rheumatol Int 35: 1707–16, 2015
Disclosure of Interest None declared