ACPA Positivity in the Elderly and Concomitant MTX Use in Younger May be Useful Predictive Factors for Superior Clinical Efficacy with Abatacept in Japanese Biological-Naïve RA Patients

Masahiro Sekiguchi¹, Takao Fujii², Masayasu Kitano¹, Kiyoshi Matsui¹, Kenji Miki³, Hideo Hashimoto⁴, Akira Yokota⁵, Aihiro Yamamoto⁶, Takashi Fujimoto⁷, Toshihiko Hidaka⁸, Naoki Shimmyo⁹, Keiji Maeda¹⁰, Takanori Kuroiwa¹¹, Ichiro Yoshii¹², Kosaku Murakami¹³, Koichiro Ohmura¹³, Satoshi Morita¹⁴, Yutaka Kawahito⁶, Norihiro Nishimoto¹⁵, Tsuneyo Mimori¹⁶ and Hajime Sano¹, ¹Division of Rheumatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan, ²Dept of Rheum/Clinical Immun, Kyoto University Graduate School of Medicine, Kyoto, Japan, ³Department of Orthopaedic Surgery, Amagasaki Central Hospital, Amagasaki, Japan, ⁴Rheumatology, Rinku Hashimoto Rheumatology Orthopaedics, Izumisano Osaka, Japan, ⁵Yokota Clinic for Rheumatology, Osaka, Japan, ⁶Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan, ⁷Nara Medical University, Kashihara, Japan, ⁸Zenjinkai Shimin-no-Mori Hospital, Miyazaki, Japan, ⁹Department of Rheumatology, Kashiba Asahigaoka Hospital, Kashiba, Japan, ¹⁰Division of Allergy, Rheumatology and Connective Tissue Diseases, Department of Internal Medicine, NTT West Osaka Hospital, Osaka, Japan, ¹¹Department of Internal Medicine, Yukioka Hospital, Osaka, Japan, ¹²Department of Orthopaedic Surgery, Yoshii Hospital, Shimanto, Japan, ¹³Rheumatology & Clin Immunology, Kyoto University Graduate School of Medicine, Kyoto, Japan, ¹⁴Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan, ¹⁵Osaka Rheumatology Clinic, Osaka, Japan, ¹⁶Dept of Rheum & Clinical Immun, Kyoto University Graduate School of Medicine, Kyoto, Japan

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: Abatacept, anti-citrullinated protein/peptide antibodies (ACPA) and methotrexate (MTX), Disease Activity

Session Information

Date: Tuesday, November 10, 2015

Title: Rheumatoid Arthritis - Small Molecules, Biologics and Gene Therapy Poster III

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose:

Sustained clinical remission is crucial in the RA. However, baseline predicting factors for sustained clinical remission in RA patients treated with abatacept (ABT) are little known.The ABROAD (ABbatacept Research Outcomes as a first-line biological Agent in the real worlD) study is the prospective multicenter observational cohort study, in which 43 institutions in the west side of Japan participate to investigate both efficacy and safety of ABT in biologic-naïve RA patients. The purpose of the present study was to determine the useful markers associated with sustained clinical remission by the intravenous ABT infusion treatment in different age groups (age ≥ 65 vs < 65 years old).

Methods:

Two-hundred and seventy-seven RA patients with high or moderate disease activity (female = 84.8%, mean age at the ABT initiation = 63.2 years old, disease duration = 7.9 years) were enrolled. DAS28-CRP remission rate at 24, 36, and 48 weeks after the initiation of ABT treatment were examined. Then, patient profiles, disease activity, concomitant drug use, and laboratory findings at baseline associated with sustained clinical remission (>12 weeks) during the last 24 weeks in the whole treatment period (48 weeks) were determined by logistic regression analysis.

Results:

The proportion of patients, who achieved DAS28-CRP-defined clinical remission at 24 and 48 weeks, were 35.1% and 36.5% in elderly patients ( ≥ 65 years old) and 34.9% and 43.4% in younger patients (< 65 years old), respectively. In elderly patients, ACPA positivity (Odds ratio [OR] = 5.378, 95% confidence interval [CI] = 1.225-38.512, p = 0.0241) was significantly associated with sustained clinical remission. In elderly patients without ACPA, a significant change in DAS28-CRP was observed only 4 weeks from baseline. However, the DAS28-CRP improved persistently until 24 weeks in the elderly patients having ACPA. On the other hand, in younger patients, concomitant MTX use (OR = 4.981, 95% CI = 1.426-23.621, p = 0.0103) was the predictive factors for sustained clinical remission. Significant improvement in the DAS28-CRP score was observed from the baseline to 12 weeks in younger patients without MTX use, while in younger patients who did use MTX, improvement was noted from the baseline to 24 weeks. Mean DAS28-CRP values were similar throughout the entire study period regardless of the presence or absence of ACPA in the younger patients group, and any concomitant MTX use in elderly patients.

Conclusion:

The efficacy of ABT in biologic-naïve RA patients was equivalent between elderly and younger patient groups, while the baseline clinical characteristics in association with clinical remission were totally different. ACPA positivity in elderly and concomitant MTX use in younger patients may be the useful predicting factors for achieving sustained clinical remission with ABT. We recommend treatment with ABT particularly for biologic-naïve RA patients who are elderly and have ACPA, and also for those who are younger and have received MTX.

Disclosure: M. Sekiguchi, None; T. Fujii, None; M. Kitano, None; K. Matsui, None; K. Miki, None; H. Hashimoto, None; A. Yokota, None; A. Yamamoto, None; T. Fujimoto, None; T. Hidaka, None; N. Shimmyo, None; K. Maeda, None; T. Kuroiwa, None; I. Yoshii, None; K. Murakami, None; K. Ohmura, None; S. Morita, None; Y. Kawahito, None; N. Nishimoto, None; T. Mimori, None; H. Sano, None.

To cite this abstract in AMA style:

Sekiguchi M, Fujii T, Kitano M, Matsui K, Miki K, Hashimoto H, Yokota A, Yamamoto A, Fujimoto T, Hidaka T, Shimmyo N, Maeda K, Kuroiwa T, Yoshii I, Murakami K, Ohmura K, Morita S, Kawahito Y, Nishimoto N, Mimori T, Sano H. ACPA Positivity in the Elderly and Concomitant MTX Use in Younger May be Useful Predictive Factors for Superior Clinical Efficacy with Abatacept in Japanese Biological-Naïve RA Patients [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/acpa-positivity-in-the-elderly-and-concomitant-mtx-use-in-younger-may-be-useful-predictive-factors-for-superior-clinical-efficacy-with-abatacept-in-japanese-biological-naive-ra-patients/. Accessed .

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