Abatacept is the only T cell co-stimulation modulator approved thus far for the treatment of moderate-to-severe
rheumatoid arthritis (RA) and is licensed for use in patients with an inadequate response to
methotrexate (MTX) and/or anti-
tumor necrosis factor (anti-TNF)
therapy. The upstream mechanism of action of
abatacept leads to downstream effects in a variety of cell types associated with the production of
autoantibodies and pro-inflammatory
cytokines implicated in RA. Accumulating data also suggest effects on other cells involved in the pathogenesis of RA, including regulatory T cells and osteoclasts. Clinical trials have demonstrated that
abatacept is an effective and well-tolerated treatment in RA. More recently, evidence from the Assessing Very Early
Rheumatoid arthritis Treatment (AVERT) trial showed that complete
drug-free remission following treatment with
abatacept may be a possibility in some patients with early RA, indicating that the disease course could be altered by early intervention. Equivalent efficacy and onset of action of
abatacept and anti-TNF
therapy have also been demonstrated in patients with an inadequate response to MTX in the
Abatacept versus
adaliMumab comParison in
bioLogic-naïvE
rheumatoid arthritis subjects with background
methotrexate (AMPLE) trial. Together, these findings support the use of
abatacept in early and established RA.