Rheumatoid arthritis

‘Provocative’: can abatacept prevent progression from subclinical to clinical RA?

Short term treatment with abatacept appears to prevent or reduce the progression of ACPA-positive arthralgia to rheumatoid arthritis.

Speaking in the first Plenary session at ACR Convergence 2021, Dr Juergen Rech, from the University of Erlangen-Nuremberg in Germany, presented interim results of the international ARIAA study.

The study randomised 100 adults considered at risk for the development of RA to either abatacept or placebo for 6 months.

Participants had to be ACPA positive, with arthralgia for at least six weeks, and with MRI-demonstrated subclinical inflammation (synovitis, tenosynovitis or osteitis) in the dominant hand.

Those with any present or past signs of swelling were excluded as were those with any history of glucocorticoid or DMARD treatment.

Dr Rech, from the University of Erlangen-Nuremberg in Germany, said this early symptomatic phase was considered a window of opportunity in which to prevent the development of RA.

“We know that ACPA emerge years before the clinical onset of RA,” he said.

“Our hypothesis was that starting treatment in RA at-risk patients in the symptomatic phase might increase the chance of reversing subclinical change in patients … or prolong time to clinical onset.”

The study found a highly significant improvement in the MRI inflammation score in patients treated with abatacept compared to placebo (61.2% v 30.6%; p = 0.0043) after six months follow-up.

The study also found progression to RA as evident by clinical joint swelling was significantly reduced in the treated versus control arms (8.2% v 34.7%; p = 0.0025).

And fewer treated participants terminated early from the trial compared to controls (14.3% v 42.9% of controls; p = 0.0032)

Dr Rech said follow-up results at 18 months from baseline had only just come through, and supported a sustained effect on inhibition of progression to arthritis.

“Abatacept is superior to placebo in improving subclinical inflammation in RA at risk patients at six months,” he concluded.

He added that use of abatacept in RA at-risk people was safe, with no new safety signals observed.

ACR president and plenary session chair Dr David Karp suggested the study was “provocative” and there may be a risk of overtreating people without a clinical diagnosis.

Dr Rech responded by saying the enriched study population, with arthralgia and MRI positive for subclinical inflammation, were very close to being RA patients but were not yet early RA.

The study was supported by BMS.

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