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Abstract
Background Abatacept (ABA), a T lymphocyte blocker, is one of the treatment options in rheumatoid arthritis (RA) patients who are resistant to initial therapy with non-biologic disease modifying drugs (DMARDs).
Objectives Aim of this study was to evaluate the effectiveness, safety and drug survival rates of ABA in RA patients registered in HUR-BIO (Hacettepe University Rheumatology Biologic Registry) database.
Methods HUR-BIO is a prospective,single center database of biological treatments including 1229 RA patients by August 2016. In total, 247 of patients had received ABA and in 175 (71%) of them ABA was the first biological agent. In this analysis, 158 patients were evaluated due to lack of first follow-up visit in 17 patients. Demographics, clinical and serological data were evaluated. DAS-28 and HAQ-DI scores before ABA and last follow-up visit were also assesed. Kaplan-Meier analysis was used to estimate drug survival rates.
Results Among 175 (82% female) patients, mean age was 53.6±11.3 and mean disease duration was 10.3±7.3. Seropositivity for RF and/or ACPA was present in 74.8% of patients. Table 1 represents DAS-28 scores of patients before ABA and last follow-up visit. Mean duration from ABA initation to first and last follow-up visit was 4.5±3.1 and 15.1±10.2 months, respectively. Female gender was found as a risk factor in terms of remaining of DAS-28 above 3.2 at first control [OR 5,63 (%95 CI 1,72–18,41)]. In first follow-up visit, improvement in DAS-28 score of ≥1,2 from baseline was more frequent in ACPA positive patients (48/62 (77.4%) vs 17/33 (51.5%), p=0.01). HAQ score of >1.0 was observed in 57.8%, 36.3%and 26.1% of patients at baseline, first follow-up visit and last follow-up visit, respectively. ABA had been cessated in 60 (38.0%) patients during follow-up. The reason for ABA withdrawal was primary unresponsiveness in 22 (36.6%) patients and infection in 2 (3.3%) patients. Drug survival for ABA was shown in Figure 1. Log- rank between RF positive and negative patients was found as 0.067.
DAS-28 scores at first and last follow-up visits
Conclusions In our database, 70% of RA patients received ABA were biologic naive. Remission or low-disease activity was achieved approximately 50% of patients in first follow-up visit with an average of 4.5 months after begining of the treatment. Functional improvement was observed in two thirds of patients. Death or life threatening side effects were not seen during follow-up. ABA is an acceptable treatment option in DMARD resistant biologic naive RA patients.
Disclosure of Interest None declared