Abatacept shows potential for subclinical arthritis
medwireNews: Findings from the ARIAA trial suggest that treatment with abatacept may reduce subclinical inflammation and delay progression to clinical disease in people at high risk for developing rheumatoid arthritis.
Speaking at the ACR Convergence 2021 virtual meeting, Jürgen Rech (University of Erlangen-Nuremberg, Germany) explained that there is a period of time in which patients experience arthralgia and have evidence of subclinical inflammation, but have not yet developed clinical arthritis. The investigators hypothesized that treating patients in this preclinical phase may represent a window of opportunity to reverse subclinical inflammation and “prolong time until clinical onset.”
Jürgen Rech outlines the findings from the ARIAA trial, which demonstrated benefits of abatacept in people at risk for rheumatoid arthritis, and discusses the potential role of treating subclinical inflammation to delay or prevent the onset of clinical disease (7:04).
The phase 3 study involved 98 participants (average age 50 years, 71% women) with anticitrullinated protein antibody positivity, evidence of inflammation on magnetic resonance imaging (MRI) in the dominant hand, and arthralgia for at least 6 weeks who were randomly assigned to receive abatacept 125 mg/week or placebo for 6 months. These people were not taking DMARDs or glucocorticoids, and had no present or past signs of swelling.
Rech reported that 61.2% of the 49 participants given abatacept experienced an improvement (>0 points) in synovitis, tenosynovitis, and/or osteitis according to the OMERACT rheumatoid arthritis MRI scoring system from baseline to 6 months.
By comparison, 30.6% of the 49 people given placebo experienced an improvement in this endpoint, a significant difference favoring abatacept.
Moreover, the researchers found that rates of progression to clinical arthritis as evidenced by joint swelling were significantly lower in the abatacept than the placebo arm, with rates of 8.2% versus 34.7% at 6 months. Rech noted that follow-up results at 18 months also showed a significant between-group difference, suggesting that that “a time-limited intervention of abatacept has a sustained effect in inhibition of progression to arthritis.”
He said that no new safety issues with abatacept emerged in the ARIAA trial. A total of 12 serious adverse events were reported during the study, including one case of pneumonia that was considered related to study treatment.
In response to a question about whether the ARIAA trial may have overtreated people who did not need to be exposed to biologics, Rech said that the requirement for participants to have arthralgia and MRI evidence of inflammation at baseline meant that the study population was “enriched [for] those patients who need to be treated because they stand too close to the door for RA.”
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