T-cell agents in the treatment of rheumatoid arthritis

T cells play a prominent role in the pathogenesis of rheumatoid arthritis. Abatacept is the first FDA approved agent for rheumatoid arthritis that blocks the activation of T cells by interrupting the interaction between the CD28 ligand on the T cell and the CD80/86 ligand on the antigen presenting cell. Inhibition of T cell activation has pleotropic effects that lowers the downstream production of multiple cytokines. In clinical trials, abatacept is effective in treating the signs and symptoms of rheumatoid arthritis as well as in inhibiting structural damage. It has a favorable safety profile and can be used in patients who may have comorbidities that preclude the use of anti-TNF agents. While no direct head to head trials exist, a study in which both abatacept and infiximab were compared to an identical control population, suggested that the efficacy of the two drugs was similar but that there were fewer adverse effects with abatacept than with infiximab. Abatacept is an important addition to the therapeutic repertoire available to treat rheumatoid arthritis. Available data support its use as a first line agent to treat patients who have had and inadequate response to methotrexate.