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Abatacept for rheumatoid arthritis
Lara Maxwell1, Jasvinder A Singh
1Institute of Population Health, University of Ottawa, 1 Stewart Street, Ottawa, Ontario, Canada, K1N 6N5.
The Cochrane Database of Systematic Reviews
|October 13, 2009
Summary
Abatacept effectively reduces disease activity and pain in rheumatoid arthritis patients, improving physical function. However, it should not be combined with other biologics due to increased serious adverse events.
Area of Science:
- Immunology
- Rheumatology
- Clinical Trials
Background:
- Rheumatoid arthritis (RA) is an autoimmune disease characterized by joint inflammation, pain, and damage.
- Abatacept targets T-cell co-stimulation, disrupting the inflammatory cascade in RA.
Purpose of the Study:
- To evaluate the efficacy and safety of abatacept in treating moderate to severe rheumatoid arthritis.
- To assess abatacept's impact on disease activity, pain, physical function, and radiographic progression.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs) identified through comprehensive database searches (CENTRAL, MEDLINE, EMBASE, etc.) up to December 2008.
- Included RCTs compared abatacept (alone or with DMARDs/biologics) against placebo or other treatments in RA patients.
- Data extraction and risk of bias assessment were performed independently by two authors; adverse event data were gathered from trials, extensions, and regulatory agencies.
Main Results:
- Seven trials involving 2908 patients demonstrated that abatacept significantly improves ACR 50 response rates (RR 2.21) compared to placebo, with a number needed to treat of 5.
- Abatacept treatment led to significant improvements in physical function, reduced disease activity, and alleviated pain.
- While abatacept slowed radiographic progression, increased overall adverse events and serious infections were noted. Combination therapy with other biologics significantly elevated serious adverse events (RR 2.30).
Conclusions:
- Abatacept demonstrates moderate-level evidence of efficacy and safety for rheumatoid arthritis treatment.
- Concomitant use of abatacept with other biologics is not recommended due to increased risks.
- Current data suggest an acceptable toxicity profile, but long-term studies and post-marketing surveillance are essential for sustained efficacy and safety assessment.
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