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The following is a summary of “Comparative effectiveness of abatacept versus TNF inhibitors in rheumatoid arthritis patients who are ACPA and shared epitope positive,” published in the January 2024 issue of Rheumatology by Harrold et al.
The HLA-DRB1 shared epitope (SE) increases the risk of developing rheumatoid arthritis (RA) and producing anti-citrullinated protein antibodies (ACPAs) in RA patients.
Researchers conducted a retrospective study to assess the practical effectiveness of abatacept compared to tumor necrosis factor inhibitors (TNFi) in RA patients positive for SE and anti-cyclic citrullinated peptide antibody (anti-CCP3).
They identified individuals who initiated treatment with either abatacept or TNFi, who were SE+ and anti-CCP3+ (> 20 U/mL) at or before starting the treatment, and who had a moderate or high CDAI score (>10) at the beginning. The primary measure they looked at was the average change in CDAI score over six months. They utilized mixed-effects models for their analyses on populations that were adjusted using propensity scores (PS) through trimming and matching, both overall and within a subgroup of individuals with previous experience with biological treatments.
The results showed that in both the overall PS-trimmed cohorts (abatacept: n = 170; TNFi: n = 157) and PS-matched cohorts (abatacept: n = 111; TNFi: n = 111), trends indicated more significant improvements in the mean change in CDAI with abatacept compared to TNFi. These differences did not reach statistical significance. Similar patterns were observed among patients with previous experience with biologic treatments, with statistical significance achieved for the mean change in CDAI in the PS-trimmed cohort (abatacept: 12.22 [95% CI (95%CI) 10.13 to 14.31]; TNFi: 9.28 [95%CI 7.08 to 11.48]; P=0.045).
Investigators concluded that, while abatacept showed numerical improvements in efficacy over TNFi for ACPA+ RA patients, only biologics-experienced patients with high disease activity had statistically significantly better CDAI scores with abatacept.
Source: advancesinrheumatology.biomedcentral.com/articles/10.1186/s42358-024-00352-4
