Session Type: Abstract Submissions (ACR)
Abatacept is a soluble, fully human fusion protein which selectively inhibits T-cell activation via the CD80/CD86:CD28 co-stimulation pathway and decreases serum levels of inflammatory cytokines and proteins implicated in the pathogenesis of psoriatic arthritis (PsA). Improvement in skin psoriasis has been shown with abatacept treatment previously with greatest reduction in PASI using 3 mg/kg dose. It has been proposed that 10 mg/kg of abatacept, the approved dose for rheumatoid arthritis may be an effective treatment choice for PsA.
The objectives of the study were (1) to study both skin and joint-related clinical outcomes prior to and 6 months after introducing abatacept treatment in PsA; (2) to investigate MRI changes of an inflamed knee joint over time in PsA patients on abatacept.
Biological treatment-naïve PsA patients fulfilling the CASPAR criteria with active disease for > 3 months (>3 swollen and >3 tender joints) with clinical synovitis of a knee and the presence of a psoriatic skin lesion were enrolled to the study. Patients were randomised to receive abatacept 3mg/kg or placebo infusion on day 1, 15 and 29; thereafter abatacept 10mg/kg was administered every 28 days for 5 months. A stable dose of methotrexate (7.5-25 mgs/week) for > 3 months prior to randomization was the only concomitant DMARD permitted in the study. Ga-enhanced MRI of the same involved knee was performed at baseline, 2 and 6 months and scored using the PsAMRIS method by one consultant radiologist. For the semi-quantitative method each knee was divided into 4 anatomical regions; medial (MED) and lateral (LAT) parapateller recesses, intercondylar notch (ICN) and suprapatellar pouch (SPP). A synovitis score ranging from 0 to 3 was assigned to each region and then added for a total synovitis score (MRS) ranging from 0 to 12 per knee.
15 patients (8 female/ 7 male) with mean age of 44.6 (±14.6) years were randomized by June 2014. Four (27%) patients were on methotrexate, the remainder did not receive any DMARDs during the study.
At baseline, mean DAS28-ESR was 4.9±1 and DAS28-CRP was 4.7±0.9. Median PASI, HAQ, PsAQol and DLQI were 3.8 (0-16.2), 1 (0-2.125), 10 (1-17) and 3 (0-27) respectively. Mean synovitis scores at MED, LAT, ICN and SPP regions were 2.07 (±0.9), 2.21 (±0.9), 1.4 (±0.8) and 1.85(±1) respectively at baseline, mean MRS was 7.6 (±3.4).
As per EULAR criteria 87.5 % of patients responded to the treatment at 6 months and 75% were good responders. Patients’ TJC68, SJC68, duration of morning stiffness, global health score, DAS28-ESR, DAS28-CRP, HAQ and PsAQol reduced significantly at 6 months compared to baseline. Median MRS decreased over the study period and was significantly lower at 6 months compared to baseline (p=0.016).
Six months of abatacept treatment reduced synovitis scores as assessed by MRI. The results of our study suggest that 10 mg/kg of abatacept is a potent treatment option in PsA.
E. J. Heffernan,
A. M. Baker,
Pfizer, Abbott, BMS, MSD, Roche, UCB,
Pfizer, Abbott, BMS, MSD, Janssen, Roche ,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/abatacept-improves-synovitis-as-assessed-by-magnetic-resonance-imaging-mri-in-psoriatic-arthritis-preliminary-analysis-from-a-single-centre-placebo-controlled-crossover-study/