Background/Purpose:

To prospectively evaluate histopathologic, blood and clinical responses to abatacept treatment in patients with primary Sjögren’s syndrome (pSS). 

Methods:

Blood, saliva and minor salivary gland biopsies were obtained prior to and after the last of 8 doses of abatacept in 11 pSS patients. Histology evaluated the number of lymphocytic foci and of B- and T-cell subtypes (CD20⁺, CD3⁺, CD4⁺, CD8⁺). The numbers of FoxP3⁺ regulatory T-cells and the FoxP3 /CD 3 ratio was calculated. The histologic data were compared with results from peripheral blood and with changes in saliva secretion.

Results:

The numbers of lymphocytic foci decreased (p=0.09) with a corresponding reduction of CD20⁺, CD3⁺, CD4⁺ and CD8⁺ T-cells. Numbers of local FoxP3⁺ T-cells decreased in 9 of 10 samples (p=0.022). In peripheral blood CD3⁺ cells did not change in numbers while CD20⁺ B cells increased (p=0.038). This increase was due to an expansion of the naïve B cell pool (p=0.012). The slight decrease in gamma globulins and IgG did not reach significance (P=0.09 and 0.169, respectively). Overall, saliva secretion did not change, however 7 of 11 patients showed an increase in saliva secretion (p=0.018 for the 7 responders).

Conclusion:

Inhibition of T cell co-stimulation using CTLA4-Ig leads to a reduced inflammation in glandular tissue with a 50% decrease in FoxP3⁺ cells, to an expansion of peripheral naïve B cells and to an increase in saliva secretion in 70% of pSS patients. In conclusion, abatacept bears the potential of a disease-modifying biologic agent in pSS.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/histological-serological-and-clinical-changes-in-response-to-abatacept-treatment-of-sjogrens-syndrome/