Objective: Assess the effect of abatacept on structural damage progression over 2 years in patients with rheumatoid arthritis (RA) with an inadequate response to methotrexate (MTX).
Methods: 539 patients entered an open-label extension of the AIM trial and received abatacept. Radiographic assessment of the hands and feet was performed at baseline, year 1 and year 2. At year 2, each patient's radiographs were scored for progression blinded to sequence and treatment allocation.
Results: In patients treated with abatacept for 2 years, greater reduction in structural damage progression was observed in year 2 than in year 1. The mean change in total Genant-modified Sharp scores was reduced from 1.07 units in year 1 to 0.46 units in year 2. Similar reductions were observed in erosion and joint space narrowing scores. Following 2 years of treatment with abatacept, 50% of patients had no progression of structural damage as defined by a change in the total score of ≤0 compared with baseline. Fifty-six percent (56%) of abatacept-treated patients had no progression during the first year compared with 45% of placebo-treated patients. In their second year of treatment with abatacept, more patients had no progression than in the first year (66% vs 56%).
Conclusion: Abatacept has a sustained effect that inhibits structural damage progression. Furthermore, the mean change in radiographic progression in patients treated with abatacept for 2 years was significantly lower in year 2 versus year 1, suggesting that abatacept may have an increasing disease-modifying effect on structural damage over time.
- rheumatoid arthritis
- structural damage