NEW YORK (Reuters Health) Dec 07 - Prompt use of abatacept plus methotrexate is advisable for rheumatoid arthritis (RA) patients with early disease but poor prognostic factors, such as erosions and rheumatoid antibodies, researchers report in the December issue of the Archives of the Rheumatic Diseases.
As lead investigator Dr. Rene Westhovens told Reuters Health, "Sustained disease remission is an achievable goal for many patients with early RA -- even with poor prognostic factors -- when treatment with a combination of abatacept and methotrexate is initiated early."
Dr. Westhovens of UZ Gasthuisberg, Leuven, Belgium, and colleagues base their advice on a study of 509 patients with RA for 2 years or less. All were methotrexate naive and most were seropositive for rheumatoid factor or anticyclic citrullinated protein type 2 (or both) and had x-ray evidence of joint erosion.
At baseline, the mean Genant-modified Sharp total score (TS) was 7.1. All patients were treated for 1 year with methotrexate; 256 were randomized to receive abatacept as well (approximately 10 mg/kg) and the remaining 253 received placebo.
At 1 year, based on mean disease activity score in 28 joints and C-reactive protein levels, 41.4% of the combination group achieved remission versus 23.3% of the monotherapy group. Also, the combination therapy group had significantly less disease progression as measured on x-rays (mean TS change, 0.63 versus 1.06).
There was no difference between the groups in frequency of adverse events (84.8% versus 83.4%), serious adverse events, serious infections, autoimmune disorders and malignancies.
Although discontinuation rates were also comparable in both groups, no patient in the combination group withdrew due to lack of efficacy, compared to 8 who received methotrexate alone.
"The fact that no patients dropped out because of lack of efficacy in the first year and the excellent safety data make this a promising treatment option in early disease," Dr. Westhovens concluded.
Ann Rheum Dis 2009;68:1870-1877.