Abatacept is Efficacious in the Treatment of Older Patients with csDMARD-Refractory Rheumatoid Arthritis: A Prospective, Multicenter, Observational Study

Sei Muraoka; Zento Yamada; Mai Kawazoe; Wataru Hirose; Hajime Kono; Shinsuke Yasuda; Yukiko Komano; Hiroshi Kawano; Toshihiko Hidaka; Shusaku Nakashima; Tsuyoshi Kasama; Tamio Teramoto; Toshihiro Nanki; ABT-ATS study group

doi:10.1007/s40744-021-00356-2

Abatacept is Efficacious in the Treatment of Older Patients with csDMARD-Refractory Rheumatoid Arthritis: A Prospective, Multicenter, Observational Study

Rheumatol Ther. 2021 Dec;8(4):1585-1601. doi: 10.1007/s40744-021-00356-2. Epub 2021 Aug 26.

Authors

Affiliations

¹ Division of Rheumatology, Department of Internal Medicine, Toho University School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan.
² Hirose Clinic of Rheumatology, Saitama, Japan.
³ Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan.
⁴ Department of Rheumatology, Endocrinology and Nephrology, Graduate School of Medicine and Faculty of Medicine, Hokkaido University, Sapporo, Japan.
⁵ Department of Rheumatology, Tokyo Medical and Dental University, Tokyo, Japan.
⁶ Department of Rheumatology, Jujo Takeda Rehabilitation Hospital, Kyoto, Japan.
⁷ Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan.
⁸ Institute of Rheumatology, Zenjinkai Miyazaki-Zenjinkai Hospital, Miyazaki, Japan.
⁹ Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Faculty of Medicine, Kagawa University, Takamatsu, Kagawa, Japan.
¹⁰ Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan.
¹¹ Teikyo Academic Research Center, Teikyo University School of Medicine, Tokyo, Japan.
¹² Division of Rheumatology, Department of Internal Medicine, Toho University School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan. toshihiro.nanki@med.toho-u.ac.jp.

Abstract

Introduction: Abatacept efficacy in older patients with rheumatoid arthritis (RA) has been primarily demonstrated via retrospective comparisons with younger patients. The objective of this study was to compare efficacy of abatacept in older vs. younger patients with RA, and efficacy of abatacept with that of conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) in both age groups.

Methods: This prospective, multicenter, observational study (UMIN000014913) enrolled csDMARD-refractory patients without previous biological DMARD treatment. Abatacept (A) or csDMARDs (C) were administered at the treating physician's discretion to older (O, ≥ 65 years) and younger (Y, 20-64 years) patients, producing AO, AY, CO, and CY groups. Clinical efficacy after 24 weeks was evaluated using European League Against Rheumatism (EULAR) erythrocyte sedimentation rate response criteria.

Results: Overall, 202 patients were evaluated. Compared with the CO group, more patients in the AO group achieved a EULAR good or moderate response (p < 0.0001). Compared with the CY group, more patients in the AY group achieved a EULAR good or moderate response (p < 0.01). Similar proportions of patients in the AO and AY groups achieved a EULAR good response or a good or moderate response. Few adverse events were reported.

Conclusions: This prospective study demonstrated that abatacept is efficacious and safe in older patients with RA and a history of being refractory to csDMARDs. Abatacept was shown to be more efficacious than adding or switching to a new csDMARD in both younger and older csDMARD-refractory patients with RA.

Trial registration: UMIN000014913.

Keywords: Abatacept; Aged; Antirheumatic agents; Prospective studies; Rheumatoid arthritis; Treatment outcome.