AB0204 Glucocorticoid-Sparing Effects of Abatacept in Rheumatoid Arthritis Are Associated with both Abatacept Effectiveness and Seropositivity
Authors: J.-E. Gottenberg, D. Courvoisier, M. Hetland, C. Turesson, H. Canhão, M.V. Hernandez, F. Iannone, E. Lie, K. Pavelka, D. Choquette, X. Mariette, A. Finckh
Journal: Annals of the Rheumatic Diseases (2016)

<h3>Background</h3> We recently reported a glucocorticoid (GC)-sparing effect of Abatacept (ABA) in patients with RA in real life practice (reference 1). <h3>Objectives</h3> To analyze the association between ABA GC-sparing effect and both disease characteristics, such as seropositivity, and abatacept effectiveness in RA patients. <h3>Methods</h3> This is a pooled analysis of nine European RA registries (ARTIS, ATTRA, BIOBADASER, DANBIO, GISEA, NOR-DMARD, ORA, SCQM, Reuma.pt) and one North-American (RHEUMDATA). Inclusion criteria were a diagnosis of RA, initiation of ABA treatment, and at least one subsequent follow-up visit with data on GC use. The basal dosage of GC was categorized as none (dose =0 mg/d), low (&gt;0 and ≤5 mg/d), moderate (&gt;5 and ≤10.0 mg/d) or high dose (&gt;10.0 mg/d). We assessed the predictors of reaching both a EULAR good/moderate responder status and stopping/tapering GC in a multivariable model including age, sex, disease duration, number of previous biologics, DAS28 at baseline (BL), RF/ACPA positivity, and concomitant treatment with methotrexate. <h3>Results</h3> Of the 1719 patients with information on GC dose, 634 (36.9%) patients were on a low, 745 (43.3%) were on moderate, and 340 (19.8%) patients were on high dose GCs at BL. Patients with moderate/high dose of GCs had significantly higher BL disease activity (mean DAS28 5.3 vs 4.9, p&lt;0.001<i>)</i> and were more frequently RF or ACPA-positive (73.6% vs 65.4%, p=0.02). Among the 373 patients who stopped or reduced GC, 276 (74.0%) were EULAR good/moderate responders at 12 months, compared to only 63.4% of those who did not reduce GC (<i>p</i>&lt;0.001). 78.4% of the patients who could stop or reduce GC within 12 months were RF positive, compared to 70.8% among those who did not reduce GC. Similarly, 74.3% of patients stopping or reducing GC were ACPA-positive, compared to 62.2% ACPA-positive patients among those who did not reduce GC. In the multivariable model, shorter disease duration (OR 0.95, 95%CI: [0.91; 0.99], p=0.01), lower number of previous biologics (OR 0.76, 95%CI: [0.59; 0.99], p=0.04), lower initial DAS28 (OR 0.56, 95%CI: [0.41; 0.77], p=0.0003), and seropositivity (OR 1.86, 95%CI: [1.09; 3.29], p=0.03) were significantly associated with stopping and reducing GC and being a EULAR good or moderate responder. <h3>Conclusions</h3> These results add further evidence to the association between seropositivity and ABA effectiveness by demonstrating that a higher proportion of patients with seropositive RA on ABA therapy are able to reduce or stop concomitant GC compared to seronegative patients, despite having higher doses of GC at baseline. <h3>References</h3> Gottenberg J, Mariette X, Hernandez MV, Iannone F, Lie E, Canhão H, Pavelka K, Turesson C, Lund Hetland M, Finckh A. Glucocorticoid-Sparing Effects of Abatacept in Real Life Practice: Data from a Paneuropean Analysis of RA Registries [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). <h3>Acknowledgement</h3> unrestricted research grant from BMS <h3>Disclosure of Interest</h3> J.-E. Gottenberg: None declared, D. Courvoisier: None declared, M. Hetland: None declared, C. Turesson: None declared, H. Canhão: None declared, M. V. Hernandez: None declared, F. Iannone: None declared, E. Lie: None declared, K. Pavelka: None declared, D. Choquette: None declared, X. Mariette: None declared, A. Finckh Grant/research support from: BMS