Abatacept reduces disease activity and ultrasound power Doppler in ACPA-negative undifferentiated arthritis: a proof-of-concept clinical and imaging study.

Abstract

OBJECTIVES:

No proven treatment exists for ACPA-negative undifferentiated arthritis (UA). The aim of this study was to evaluate whether abatacept is effective in treating poor prognosis, ACPA-negative UA, including its effect on power Doppler on US (PDUS).

METHODS:

A proof-of-concept, open-label, prospective study of 20 patients with DMARD-naïve, ACPA-negative UA (⩾2 joint synovitis) and PDUS ⩾ 1 with clinical and 20-joint US (grey scale/PDUS) assessments at baseline, 6, 12, 18 and 24 months. All patients received 12 months of abatacept (monotherapy for minimum first 6 months). The primary end point was a composite of the proportion of patients that at 6 months achieved DAS44 remission, a maximum of one swollen joint for at least 3 consecutive months and no radiographic progression (over 0-12 months).

RESULTS:

Twenty of the 23 patients screened were enrolled [14 female; mean (sd) age 53.4 (11.2) years, symptom duration 7.5 (0.9) months]. Two (10%) achieved the composite primary end point. A reduction in the mean (sd) DAS44 was observed from a baseline value of 2.66 (0.77) to 2.01 (0.81) at 6 months and to 1.78 (0.95) at 12 months. The DAS44 remission rates were 6/20 (30%; 95% CI: 15, 51%) at 6 months and 8/20 (40%; 95% CI: 22, 62%) at 12 months. A striking decrease in the median (interquartile range; IQR) total PDUS score was noted from 10 (4-23) at baseline to 3 (2-12) and 3 (0-5) at 6 and 12 months, respectively.

CONCLUSION:

This report is a first in potentially identifying an effective therapy, abatacept monotherapy, for poor-prognosis, ACPA-negative UA, supported by a clear reduction in PDUS. These data justify evaluation in a controlled study.

• Authors: Maya H Buch, Elizabeth M A Hensor, Chadi Rakieh, Jane E Freeston, Edward Middleton, Sarah Horton, Sudipto Das, Charles Peterfy, Ai Lyn Tan, Richard J Wakefield, Paul Emery
• Journal: Rheumatology (Oxford, England) (Rheumatology (Oxford)) Vol. 56 Issue 1 Pg. 58-67 (01 2017) ISSN: 1462-0332 [Electronic] England
• PMID: 28028155 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © The Author 2016. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: [email protected].

Chemical References

• Antirheumatic Agents
• Peptides, Cyclic
• cyclic citrullinated peptide
• Abatacept
• Rheumatoid Factor

Topics

• Abatacept (therapeutic use)
• Adult
• Antirheumatic Agents (therapeutic use)
• Arthritis (diagnostic imaging, drug therapy, immunology)
• Arthritis, Rheumatoid (diagnostic imaging, drug therapy, immunology)
• Female
• Hand Joints (diagnostic imaging)
• Humans
• Knee Joint (diagnostic imaging)
• Male
• Middle Aged
• Patient Reported Outcome Measures
• Peptides, Cyclic (immunology)
• Prospective Studies
• Radiography
• Remission Induction
• Rheumatoid Factor (immunology)
• Severity of Illness Index
• Synovitis (diagnostic imaging, drug therapy, immunology)
• Ultrasonography, Doppler