Abatacept Potentially Optimal for Refractory Rheumatoid Arthritis

By Patrick Daly - July 26, 2023

Co-first authors of a study published in Advances in Rheumatology, Alisson Pugliesi and Amanda Borges de Oliveira, led a network meta-analysis to compare the efficacy of rituximab, tocilizumab, and abatacept in patients with rheumatoid arthritis who developed resistance to methotrexate or tumor necrosis factor inhibitor (TNFi) treatment.

Rituximab, abatacept, and tocilizumab all reportedly achieved similar rates of American College of Rheumatology ≥70% disease activity improvement (ACR70) outcomes at 6 months; however, authors noted there was a high degree of heterogeneity between the included trials.

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The researchers attempted to mathematically equalize imbalanced factors between the randomized, controlled trials and compared efficacy again using multivariate metaregressions. Based on this analysis, they estimated abatacept potentially improved the odds of achieving ACR70 responses by 2.2-fold compared with tocilizumab.

Analysts identified 19 randomized, controlled trials on biologic disease-modifying antirheumatic drugs that enrolled a total of 7835 patients with rheumatoid arthritis refractory to methotrexate or TNFi therapy. The mean study duration was 1.2 years.

According to the report, the 3 critically imbalanced factors between rituximab, abatacept, and tocilizumab studies were baseline health assessment questionnaire score, study duration, and TNFi treatment frequency in the control group.

After adjusting for these factors, Pugliesi, Borges de Oliveira, and colleagues stated the heterogeneity between the studies was reduced (I2=24%) and their model’s power was increased (R2=85%).

This model found abatacept had a risk ratio of 2.217 for achieving ACR70 compared with tocilizumab (95% CI, 1.554-3.161; P<.001) and a risk ratio of 1.773 compared with rituximab (95% CI, 0.113-10.210; P<.765).

Ultimately, the study’s authors suggested abatacept or rituximab should be evaluated before tocilizumab in patients with refractory rheumatoid arthritis, though they acknowledged that “novel head-to-head clinical trials are still needed to confirm these findings.”

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