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Predictive factors for structural remission using abatacept: Results from the ABROAD study.

Kosaku Murakami1, Masahiro Sekiguchi2,3, Shintaro Hirata4

  • 1a Department of Rheumatology and Clinical Immunology, Graduate School of Medicine , Kyoto University , Kyoto , Japan.

Modern Rheumatology
|May 30, 2018
PubMed
Summary

Abatacept (ABA) effectively prevents joint destruction in early rheumatoid arthritis (RA) patients. Shorter disease duration and slower baseline progression predict sustained structural remission with ABA therapy.

Keywords:
Abataceptfirst biological DMARDsradiographic progressionrheumatoid arthritis

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Area of Science:

  • Rheumatology
  • Immunology
  • Clinical Medicine

Background:

  • Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by joint inflammation and destruction.
  • Biological disease-modifying anti-rheumatic drugs (bDMARDs) are crucial in managing RA, but real-world effectiveness in treatment-naïve patients requires further investigation.
  • Abatacept (ABA) is a selective T-cell costimulation modulator used in RA treatment.

Purpose of the Study:

  • To evaluate the efficacy of abatacept (ABA) in preventing joint destruction in rheumatoid arthritis (RA) patients who have not previously used bDMARDs.
  • To identify baseline predictors of structural remission (St-REM) in this patient population treated with ABA as a first-line biologic agent.

Main Methods:

  • The ABROAD study cohort included RA patients with moderate-to-high disease activity treated with ABA as their initial bDMARD.
  • Radiographic changes were assessed using the van der Heijde's modified Total Sharp Score (mTSS) from baseline to 1 year.
  • Predictive factors for achieving St-REM (defined as ΔmTSS ≤0.5/year) were analyzed.

Main Results:

  • Out of 118 patients, 67.5% achieved St-REM.
  • Independent baseline predictors for St-REM included disease duration less than 3 years (OR=3.152) and slower radiographic progression (baseline mTSS/year <3, OR=3.727).
  • Achieving clinical remission by 24 weeks significantly increased St-REM prevalence.

Conclusions:

  • Shorter disease duration and less radiographic progression at baseline are key predictors of sustained structural remission with ABA therapy.
  • A rapid clinical response to ABA treatment further enhances the likelihood of achieving long-term structural remission in bDMARD-naïve RA patients.