ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 610

Baseline Structural Damage Predicts Response to Abatacept in Patients with Psoriatic Arthritis: A Post Hoc Analysis from a Phase III Study

Georg Schett1, T Lehman2, HA Ahmad2, A Johnsen2, S Banerjee2 and Philip J Mease3, 1University of Erlangen-Nuremberg, Erlangen, Germany, 2Bristol-Myers Squibb, Princeton, NJ, 3Swedish Medical Center and University of Washington, Seattle, WA

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords:

Session Information

Date: Sunday, November 5, 2017

Title: Spondyloarthropathies and Psoriatic Arthritis – Clinical Aspects and Treatment Poster I

Session Type: ACR Poster Session A

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

Background/Purpose: Psoriatic arthritis (PsA) is a heterogeneous disease in which treatment selection and patient stratification based on clinical domains have recently been proposed.1 The efficacy and safety of the co-stimulation modulator abatacept in patients with PsA was investigated in the Phase III ASTRAEA study (NCT01860976).2 The aim of this analysis was to identify baseline factors that predict response to abatacept treatment in patients with PsA in ASTRAEA.   Methods: Baseline disease and demographic characteristics of patients treated with abatacept (n=213) or placebo (n=211) in the Phase III ASTRAEA study achieving high-level response (ACR50: abatacept n=41, placebo n=26; ACR70: abatacept n=22, placebo n=14) at Day 169 (Week 24) were compared with those of patients not achieving an ACR20 response (abatacept n=129, placebo n=164). Due to the inclusion of an early escape (EE) at Day 114 (Week 16), patients who entered the EE were imputed as non-responders at Day 169 and included in the ACR20 non-responders group. Results: For both the abatacept and placebo groups, most baseline demographic and disease characteristics, including age, BMI, disease duration and disease activity at baseline, were similar among ACR50 and ACR70 responders and ACR20 non-responders (Table, abatacept group). Joint-space narrowing, erosion, total PsA-modified Sharp/van der Heijde scores, and the swollen joint count, however, were higher in abatacept ACR50 and ACR70 responders than in ACR20 non-responders. Conversely, placebo ACR 20 non-responders show a higher degree of baseline structural damage than ACR50 and ACR70 responders. Baseline CRP was higher in both abatacept and placebo ACR50 and ACR70 responders than in ACR20 non-responders.

Conclusion: These data show that a higher degree of baseline structural joint damage and higher swollen joint count is associated with a greater response to abatacept therapy in PsA. These observations suggest that PsA patients with signs of synovitis-driven osteoclast formation and disease activity including swollen joints and structural damage may be good candidates for abatacept treatment. These results are in accordance with recent data showing that CTLA-4 controls osteoclast differentiation and bone resorption3 and the known mechanism of abatacept on T-cell co-stimulation mediated inflammation2. 1.    Coates L, et al. Arthritis Rheumatol 2016;68:1060–71. 2.    Mease P, et al. Ann Rheum Dis 2017 May 4; Epub ahead of print. 3.    Bozec A, et al. Sci Transl Med 2014;6:235ra60.  

Table. Baseline Disease Characteristics in ACR20 Non-responders, ACR50 Responders and ACR70 Responders to Abatacept

 

ACR20
non-responders (n=129)

ACR50 responders (n=41)

ACR70 responders (n=22)

Age (years)

51.5 (10.3)

50.2 (11.7)

49.1 (10.9)

BMI (kg/m2)

31.7 (7.1)

28.4 (4.0)

29 (4.4)

Duration of PsA (years)

8.7 (8.8)

7.6 (6.9)

7.0 (6.2)

Tender joints

20.1 (12.8)

20.1 (12.8)

22.5 (12.7)

Swollen joints

10.8 (7.0)

14.1 (8.5)

15.5 (8.0)

DAS28 (CRP)

4.9 (1.0)

5.0 (1.1)

5.3 (0.8)

Joint-space narrowing score

6.7 (16.4)

16.6 (36.3)

10.5 (34.9)

Erosion score

9.5 (20.7)

21.8 (48.1)

14.3 (41.1)

Total SHS score

16.2 (36.6)

38.4 (84.0)

24.8 (75.8)

Baseline CRP (mg/L)

13 (21.8)

15.5 (18.0)

14.7 (18.5)

Data are expressed as mean (SD)

PsA=psoriatic arthritis; SHS=Sharp/van der Heijde score

 
Disclosure: G. Schett, None; T. Lehman, Bristol-Myers Squibb, 3,Bristol-Myers Squibb, 1, 9; H. Ahmad, Bristol-Myers Squibb, 3,Bristol-Myers Squibb, 1, 9; A. Johnsen, Bristol-Myers Squibb, 1,Bristol-Myers Squibb, 3; S. Banerjee, Bristol-Myers Squibb, 1,Bristol-Myers Squibb, 3; P. J. Mease, AbbVie, Amgen, BMS, Celgene, Janssen, Lilly, Novartis, Pfizer, Sun, UCB, 2,AbbVie, Amgen, BMS, Celgene, Crescendo Bioscience, Corrona, Demira, Janssen, Lilly, Novartis, Pfizer, Sun, UCB, Zynerba, 5,Amgen, BMS, Celgene, Crescendo Bioscience, Genentech, Janssen, Novartis, Pfizer, UCB, 8.

To cite this abstract in AMA style:

Schett G, Lehman T, Ahmad H, Johnsen A, Banerjee S, Mease PJ. Baseline Structural Damage Predicts Response to Abatacept in Patients with Psoriatic Arthritis: A Post Hoc Analysis from a Phase III Study [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/baseline-structural-damage-predicts-response-to-abatacept-in-patients-with-psoriatic-arthritis-a-post-hoc-analysis-from-a-phase-iii-study/. Accessed .

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