Abatacept 'safe and effective' after non-response to anti-TNF
Published on 07 January 2013
Patients with severe rheumatoid arthritis who have failed to respond to anti-tumour necrosis factor (anti-TNF) therapy and rituximab may benefit from using abatacept, a study has shown.
Abatacept is a type of biologic therapy which is sometimes used when other treatment approaches - including non-biologic disease-modifying anti-rheumatic drugs (DMARDs) and biologics such as anti-TNFs - have failed.
Unlike anti-TNF therapy, which blocks the inflammatory TNF protein, abatacept works by attaching to the surface of inflammatory cells and blocking communication between them, thereby reducing inflammation.
To study the safety and efficacy of abatacept in patients who had failed on previous therapies, researchers in Canada studied 23 people, all of whom had severe rheumatoid arthritis.
Participants had an average age of 56 years and the majority (16) were women. All of the patients had failed on more than one DMARD and on anti-TNF drugs.
They were started on abatacept infusions alongside methotrexate or an alternative DMARD and the researchers recorded any changes in disease activity and symptoms over the next few months.
After an average of 9.6 months of treatment with abatacept, the researchers observed that patients typically benefited from a reduction in overall disease activity, including the number of swollen and tender joints, and an improvement in functional ability.
Almost four-fifths (78 per cent) of participants had experienced a good or moderate response according to EULAR criteria, including eight patients who achieved a response within the first three months of treatment with abatacept.
Thirty per cent of patients achieved remission, with prior use of rituximab not appearing to influence the chances of abatacept's efficacy.
The researchers also observed that abatacept had a good level of safety, with no serious infections or other side-effects recorded.
Publishing their findings in the Journal of Clinical Rheumatology, the study authors concluded: "Although our safety data are limited to short-term follow-up, our observations suggest that abatacept is safe to use in patients who have failed to respond to anti-TNF therapy and rituximab."
A spokesman for Arthritis Research UK commented: "Currently the National Institute for Health and Clinical Excellence (NICE) doesn't recommend abatacept for people who don't respond to more conventional disease-modifying drugs (DMARDs) as it doesn't work as well as other available treatments and is more expensive.
"However, this research suggests it offers more treatment options for some patients."