Presence of Anti-Cyclic Citrullinated Peptide Antibodies Is Associated with Better Treatment Response to Abatacept but Not to TNF Inhibitors in Patients with RA: A Meta-Analysis

E Alemao¹, R Postema², Y Elbez³, C Mamane⁴ and Axel Finckh⁵, ¹Bristol-Myers Squibb, Princeton, NJ, ²Bristol-Myers Squibb, Uxbridge, United Kingdom, ³Excelya, Boulogne-Billancourt, France, ⁴Mapi, London, United Kingdom, ⁵University Hospital of Geneva, Geneva, Switzerland

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: anti-CCP antibodies, meta-analysis and treatment

Session Information

Date: Monday, November 6, 2017

Title: Health Services Research Poster II: Osteoarthritis and Rheumatoid Arthritis

Session Type: ACR Poster Session B

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

Background/Purpose: The association between anti-citrullinated protein antibody (ACPA) status and erosions, as well as response to TNF inhibitor (TNFi) treatment, has been explored.^1,2 Results based on a large US RA registry study have suggested that anti-cyclic citrullinated peptide (anti-CPP; a surrogate for ACPA) positivity predicts better clinical responses to abatacept, but not to TNFi.³ The objective of this study was to investigate whether ACPA status is associated with clinical responses to abatacept or to TNFi in RA, in the published literature Methods: A systematic literature review (SLR) was performed to identify published studies and conference abstracts estimating biologic DMARD response according to ACPA status. The SLR was supplemented by additional studies that were identified through expert input. Mantel–Haenszel meta-analysis methods were used to pool risk ratios (RRs) based on ACPA status. In the base-case, response to therapy was assessed using the EULAR response as the primary outcome, while a scenario analysis assessed response by combining various definitions including ACR20 and EULAR for abatacept, and ACR20, DAS28 and EULAR for TNFi therapy. Results: Nineteen studies were included in the meta-analysis: 4 for abatacept, 14 for TNFi and 1 for both treatments. The base-case analysis included 4 of the abatacept and 6 of the TNFi studies and showed a statistically significant positive association between ACPA positivity and EULAR response for patients treated with abatacept (RR 1.13 [95% CI 1.00, 1.26]; Figure 1), while ACPA positivity was associated with lower EULAR responses to TNFi therapy (RR 0.92 [95% CI 0.86, 0.98]; Figure 2). For the scenario analyses, in which all definitions of response were pooled, the results were consistent with base-case for abatacept (RR 1.18 [95% CI 1.30, 1.35]), while for TNFi therapy, no significant difference by ACPA status was observed (RR 0.97 [95% CI 0.86, 1.10]).

Conclusion: This meta-analysis confirms that ACPA-positive RA patients are more likely to achieve response to abatacept treatment compared to ACPA-negative patients. Additionally, the analysis demonstrates that there is no association between ACPA status and response to TNFi therapy, consistent with the findings of previously published studies.^1,3 1. Lv Q, et al. PLoS One 2014;9:e89442. 2. Jilani AA and Mackworth-Young CG. Int J Rheumatol 2015;2015:72810. 3. Harrold LR, et al. J Rheum 2017 [Epub ahead of print].

Disclosure: E. Alemao, Bristol-Myers Squibb, 1,Bristol-Myers Squibb, 3; R. Postema, Bristol-Myers Squibb, 1,Bristol-Myers Squibb, 3; Y. Elbez, None; C. Mamane, Mapi, 3,Bristol-Myers Squibb, 5; A. Finckh, AbbVie, A2BIO, BMS, MSD, Pfizer, and Roche, 5.

To cite this abstract in AMA style:

Alemao E, Postema R, Elbez Y, Mamane C, Finckh A. Presence of Anti-Cyclic Citrullinated Peptide Antibodies Is Associated with Better Treatment Response to Abatacept but Not to TNF Inhibitors in Patients with RA: A Meta-Analysis [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/presence-of-anti-cyclic-citrullinated-peptide-antibodies-is-associated-with-better-treatment-response-to-abatacept-but-not-to-tnf-inhibitors-in-patients-with-ra-a-meta-analysis/. Accessed .

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