Body mass does not affect the clinical response to intravenous abatacept in patients with rheumatoid arthritis

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Body mass does not affect the clinical response to intravenous abatacept in patients with rheumatoid arthritis

Obesity possess a major health risk and has attracted the attention due to its strong association with metabolic and cardiovascular diseases. Understanding of rheumatoid arthritis (RA) and advancements in its management are important for early intervention, specially in patients with evidence of aggressive, erosive disease that can prevent the irreversible structural damage characteristic of RA. Some evidences suggest that obesity impairs the effectiveness of tumor necrosis factor (TNF) inhibitors.

Combination treatment with both traditional and biologic disease-modifying antirheumatic drugs (DMARDs) are proven to be effective and offer better outcomes. Clinical practice guidelines have also recommended this approach for patients in whom conventional DMARDs approach did not improve the symptoms. However, combination therapy should be considered early in DMARD-naive patients, who have poor prognostic factors such as erosion, positivity for anti-cyclic citrullinated peptide (anti-CCP) or rheumatoid factor (RF) and with high disease activity.

Iannone F and colleagues assessed the T-cell co-stimulation modulator abatacept for its use in patients with very early stage arthritis/early RA who are methotrexate-naive and in patients who already have RA and showed adequate response to the methotrexate or TNF inhibitors. Data from relevant clinical trials was assessed to study the clinical efficacy of abatacept in early disease. The focus was to study the clinical outcomes over long-term treatment in different patient populations and the effects of abatacept on structural damage.

In this pooled analysis, all the patients with available BMI were included. The primary endpoint was drug retention of abatacept in the different BMI categories. Multivariable Cox regression was used to estimate hazard ratios (HR) for drug discontinuation.

 A secondary endpoint was EULAR/LUNDEX response rates at 6/12 months. Total 2015 RA patients received IV abatacept, of which, 380 (18.9%) were classified as obese. Obese patients showed more functional disability, and were less often RF positive. The median abatacept retention time was 1.91 years for obese RA patients compared to 2.12 years for non-obese patients (p=0.15). The risk of abatacept discontinuation was not significantly different for overweight (HR 1.03 (95% CI 0.89–1.19)), or for obese (HR:1.08 (95% CI 0.89–1.30)) as compared to normal-weight patients. Rheumatoid factor positivity reduced the risk of abatacept discontinuation (HR: 0.83 (95% CI 0.72–0.95)), while previous biologic therapy was positively associated with drug interruption (HRs increasing from 1.68 to 2.16 with the line of treatments). Obese and non-obese patients attained the similar rates of EULAR/LUNDEX clinical response at 6/12 months. Therefore, it was concluded that drug retention and clinical response rates to abatacept do not seem to be decreased by obesity in RA patients.

Source:

Clinical Rheumatology

Link to the source:

http://link.springer.com/article/10.1007%2Fs10067-016-3505-5

Original title of article:

Body mass does not impact the clinical response to intravenous abatacept in patients with rheumatoid arthritis. Analysis from the “pan-European registry collaboration for abatacept (PANABA)

Authors:

Florenzo Iannone, Delphine S.Courvoisier, Jacques Eric Gottenberg, Maria Victoria Hernandez, Elisabeth Lie, Helena Canhão, Karel Pavelka, Merete Lund Hetland, Carl Turesson, Xavier Mariette, Denis Choquette, Axel Finckh

Clinical Rheumatology
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