The Long-Term Effectiveness and Safety of Abatacept in Rheumatoid Arthritis

Introduction

In recent years several biological drugs with a mode of action different from TNF blockade became available, all providing a rational strategy to treat RA: Rituximab, an anti-B-cell therapy; Tocilizumab, an anti-IL6 therapy; and Abatacept, a costimulation blocker. Primary efficacy results in RCTs of these three therapies seem comparable at 6 months.1–3 Recent meta analyses suggest slight differences in efficacy and/or safety in indirect comparisons of different biological therapies specifically at 6 months,4, 5 but ultimately head-to-head studies are needed to correctly evaluate the different impact of these biologics. In the mean time, detailed subanalyses of the available literature can shed light on distinct efficacy and safety profiles of drugs providing guidance for the practicing rheumatologist. The current review focuses on long-term data of Abatacept, a soluble, fully human, recombinant fusion protein that selectively modulates the CD80/CD86:CD28 costimulatory signal needed for full T-cell activation,6 which is important to judge long-term effectiveness of this drug. The current review is not based on a systematic literature review comparing Abatacept with other biologics as the methodology in reporting results across different trial extensions is not standardized and patient populations studied are not comparable.

Abstract

Several biological drugs with a mode of action different from TNF blockade are currently available for the treatment of rheumatoid arthritis (RA). Since there are no data in literature to compare the different biologicals head-to-head, rheumatologists currently base their treatment decisions on literature reviews and registry data. One of these drugs is Abatacept, a costimulation modulator. A careful analysis of the different extension trials of Abatacept provides interesting insights in the specific efficacy and safety profile that might contribute to the understanding and the appropriate use of this latter drug. Long-term attrition on the drug in these extensions, increasing clinical and X-ray improvements over time, important and stable responses over years, particular improvements in patient-centered outcomes, but also long-term safety, and easy administration with low rates of perfusion reactions will be discussed.

Keywords

Abatacept, long-term outcome, efficacy, safety