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Abstract Number: 0455

Abatacept Reverses Subclinical Arthritis in Patients with High-risk to Develop Rheumatoid Arthritis -results from the Randomized, Placebo-controlled ARIAA Study in RA-at Risk Patients

Juergen Rech1, Mikkel Ostergaard2, Koray Tascilar3, Melanie Hagen4, Larissa Valor Mendez4, Arnd Kleyer4, Gerhard Kroenke4, David Simon5, Verena Schoenau4, Axel Hueber6, Stefan Kleinert7, Xenofon Baraliakos8, Martin Fleck9, Andrea Rubbert-Roth10, Frank Behrens11, David Kofler12, Martin Feuchtenberger13, Michael Zaenker14, Reinhard Voll15, Cornelia Glaser16, Eugen Feist17, Gerd Burmester18, Kirsten Karberg19, Johannes Strunk20, Juan D Cañete21, Esperanza Naredo22, Maria Filkova23, Ladislav Senolt24 and Georg Schett25, 1Friedrich-Alexander University (FAU) Erlangen-Nuernberg and Universitaetsklinikum Erlangen, Department of Internal Medicine 3 - Rheumatology and Immunology, Germany, Erlangen, Germany, 2Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, and Department of Clinical Medicine, University of Copenhagen, Glostrup, Denmark, 3Friedrich Alexander University of Erlangen Nuremberg, Universitaetsklinikum Erlangen Department of Medicine-3 Rheumatology and Immunology, Erlangen, Germany, 4Friedrich-Alexander University (FAU) Erlangen-Nuernberg and Universitaetsklinikum Erlangen, Medical Department 3, Rheumatology & Immunology, Erlangen, Germany, 5Department of Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nrnberg, Erlangen, Germany, 6sozialstiftung-bamberg.de, Bamberg, Germany, 7Praxisgemeinschaft Rheumatologie - Nephrologie (PGRN), Erlangen, Germany, 8Rheumazentrum Ruhrgebiet, Herne, Germany, 9Asklepios Klinikum Bad Abbach Klinik und Poliklinik für Rheumatologie/ Klin. Immunologie, Bad Abbach, Germany, 10Kantonspital St Gallen, St.Gallen, Switzerland, 11Rheumatology & Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Fraunhofer Cluster Immune-Mediated Diseases (CIMD), Fraunhofer Cluster Immune-Mediated Diseases (CIMD), Frankfurt/Main, Germany, 12Division of Rheumatology and Clinical Immunology, Department I of Internal Medicine; University Hospital Cologne, Cologne, Germany, 13MED | BAYERN OST GmbH Fachbereich Rheumatologie, Burghausen, Germany, 14Immanuel Klinikum Bernau Herzzentrum Brandenburg, Bernau, Germany, 15Department of Rheumatology and Clinical Immunology, University Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany, 16Universitätsklinikum Freiburg Klinik für Rheumatologie und Klinische Immunologie, Freiburg, Germany, 17Helios Department of Rheumatology, Vogelsang-Gommern, Germany, 18Charité University Medicine Berlin, Berlin, Germany, 19Praxis für Rheumatologie und Innere Medizin, Berlin, Germany, 20Krankenhaus Porz am Rhein GmbH Rheumaklinik, Köln (Porz), Germany, 21Rheumatology Department, Hospital Clinic, Barcelona, Spain, 22Department of Rheumatology and Joint and Bone Research Unit, Hospital Fundación Jiménez Díaz and Autónoma University, Madrid, Spain, 23Institute of Rheumatology and Connective Tissue Research Laboratory, Department of Rheumatology of First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic, 24Institute of Rheumatology, Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic, 25Universitätsklinikum Erlangen, Department of Internal Medicine 3 – Rheumatology and Immunology, Erlangen, Germany, Erlangen, Germany

Meeting: ACR Convergence 2021

Keywords: Anti-CCP, autoimmune diseases, Biomarkers, clinical trial, rheumatoid arthritis

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Session Information

Date: Saturday, November 6, 2021

Title: Plenary I (0453–0457)

Session Type: Plenary Session

Session Time: 11:15AM-11:30AM

Background/Purpose: Rheumatoid arthritis (RA) has a preclinical phase that is characterized by the presence of antibodies against citrullinated proteins (ACPA), subclinical arthritis and pain. ACPA emerge years before the clinical onset of RA. In a subset of such individuals with ACPA (but not yet RA) imaging studies have revealed the presence of inflammatory and structural lesions. This subset of patients is at increased risk for the development of RA. As T cell mediated B cell activation is a key step for triggering the onset of autoimmune inflammatory diseases, such as RA, interventions that target this process may be useful for very early interventions, ultimately preventing the onset of RA. Abatacept appears to be an attractive approach in such task, as it interrupts the activation of T cells and has a well-known favourable safety profile in the treatment of RA.

To test whether abatacept, compared to placebo, reverses subclinical arthritis in patients with ACPA and MRI signs of inflammation, who have not yet developed RA.

Methods: ARIAA is a randomized double-blinded placebo-controlled multi-center study in RA-at risk individuals that ACPA positive and show MRI signs of inflammation. The study is composed by a 6 months treatment phase with either abatacept s.c. 125 mg weekly or placebo and 12 months follow up with no treatment. The primary analysis is done on the ITT population and missing values were rated as treatment failures. The primary endpoint was defined as an improvement in at least one of the MRI inflammation parameters (any change from baseline > 0 assessing synovitis, tenosynovitis and osteitis) according to the RAMRIS score.

Results: Between November 2014 and December 2019 a total of 139 patients were included into ARIAA by 14 study sites (11 in Germany, 1 in the Czech Republic and 2 in Spain). Of them, 100 patients were randomized to receive either abatacept or placebo. Two patients were excluded from the ITT population. As a result, 98 patients could be evaluated for efficacy and safety. The primary endpoint of ARIAA was reached: 61% of the patients in the abatacept group improved in at least one of the MRI parameters (synovitis, tenosynovitis, and osteitis) compared to only 31% in the placebo group (p=0.0043). Moreover, arthritis developed in 17 patients in the placebo group (34.7%) but only 4 patients (8.2%) in the abatacept group (p= 0.0025).
12 serious adverse events (1 gastritis, 1 cellulitis, 1 pneumonia, 1 tendinitis calcificans, 1 Rotator cuff syndrome, 1 Cholelithiasis, 1 x peripheral arterial occlusive disease, 1 x chronic idiopathic pain syndrom, 1 prostate cancer, 1 penile neoplasm; 1 trabeculectomy, 1 cataract operation) have been reported between 2014 – 2021, with only one (pneumonia) was assessed to have a causal relationship to study treatment.

Conclusion: These data show that abatacept significantly improves subclinical arthritis in patients at high risk to develop RA. In addition, the data also support the concept that early intervention may prevent or at least delay the development of RA.


Disclosures: J. Rech, Novartis, 2, 5, 6, SOBI, 2, 5, 6, AbbVie, 2, 6, Biogen, 2, 6, BMS, 2, 6, Chugai, 2, 6, GSK, 2, 6, Janssen, 2, 6, Lilly, 2, 6, MSD, 2, 6, Mylan, 2, 6, Roche, 2, 6, Sanofi, 2, 6, UCB, 2, 6; M. Ostergaard, AbbVie, 2, 5, 6, Bristol-Myers Squibb, 2, 6, Celgene, 2, 6, Novartis, 2, 5, 6, Boehringer Ingelheim, 2, 6, Eli Lilly, 2, 6, Hospira, 2, 6, Janssen, 2, 6, Merck, 2, 5, 6, Novo, 2, 6, Orion, 2, 6, Pfizer Inc, 2, 6, Regeneron, 2, 6, Roche, 2, 6, UCB, 2, 6, GSK, 2, 6, Mundipharma, 2, 6, Schering-Plough, 2, 6, Takeda, 2, 6, Wyeth, 2, 6, Centocor, 2, 5, 6; K. Tascilar, None; M. Hagen, None; L. Valor Mendez, None; A. Kleyer, None; G. Kroenke, None; D. Simon, None; V. Schoenau, None; A. Hueber, None; S. Kleinert, Novartis, 5, Abbvie, 1, Siemens Healthineers, 1, Sanofi, 11; X. Baraliakos, None; M. Fleck, None; A. Rubbert-Roth, AbbVie, 2, 6, Bristol-Myers Squibb, 2, 6, Chugai, 2, 6, Roche, 2, 6, Gilead, 2, 6, Janssen, 2, 6, Eli Lilly, 2, 6, Sanofi, 2, 6, Amgen, 2, 6, Novartis, 2, 6; F. Behrens, Chugai, 5, 6, AbbVie, 6, Amgen, 6, GlaxoSmithKline, 5, Janssen, 5, 6, Pfizer, 5, 6, Roche, 5, 6, Boehringer Ingelheim, 6, Celgene, 6, Eli Lilly, 6, Merck, 6, Novartis, 6, Sanofi, 6, UCB, 6; D. Kofler, None; M. Feuchtenberger, None; M. Zaenker, None; R. Voll, None; C. Glaser, None; E. Feist, R-Pharm, 2, 6, Abbvie, 2, 6, Novartis, 2, 5, 6, Pfizer, 2, 5, 6, AB2Bio, 6, BMS, 6, Celgene, 6, Janssen, 6, Eli Lilly, 2, 5, 6, Medac, 6, MSD, 6, Roche/Chugai, 2, 5, 6, Sanofi, 6, Sobi, 6, UCB, 6; G. Burmester, AbbVie, 2, 5, 6, Eli Lilly, 2, 5, 6, MSD, 2, 5, 6, Pfizer, 2, 5, 6, Roche, 2, 5, 6, Sanofi, 2, 5, 6, UCB, 2, 5, 6, Galapagos, BV, 2, 6, Gilead Sciences, Inc., 2, 6; K. Karberg, None; J. Strunk, None; J. Cañete, Abbvie, 6, Pfizer, 6, Janssen, 6; E. Naredo, AbbVie, 6, Roche, 6, BMS, 6, Pfizer, 6, UCB, 6, Lilly, 5, 6, Novartis, 6, Janssen, 6, Celgene GmbH, 6; M. Filkova, None; L. Senolt, None; G. Schett, Janssen, 6, Novartis, 6, AbbVie, 6, Bristol Myers Squibb, 6, Celgene, 6, Eli Lilly, 6, UCB, 6, Roche, 6.

To cite this abstract in AMA style:

Rech J, Ostergaard M, Tascilar K, Hagen M, Valor Mendez L, Kleyer A, Kroenke G, Simon D, Schoenau V, Hueber A, Kleinert S, Baraliakos X, Fleck M, Rubbert-Roth A, Behrens F, Kofler D, Feuchtenberger M, Zaenker M, Voll R, Glaser C, Feist E, Burmester G, Karberg K, Strunk J, Cañete J, Naredo E, Filkova M, Senolt L, Schett G. Abatacept Reverses Subclinical Arthritis in Patients with High-risk to Develop Rheumatoid Arthritis -results from the Randomized, Placebo-controlled ARIAA Study in RA-at Risk Patients [abstract]. Arthritis Rheumatol. 2021; 73 (suppl 9). https://acrabstracts.org/abstract/abatacept-reverses-subclinical-arthritis-in-patients-with-high-risk-to-develop-rheumatoid-arthritis-results-from-the-randomized-placebo-controlled-ariaa-study-in-ra-at-risk-patients/. Accessed .
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