201. Impact of intravenous abatacept on synovitis, osteitis and structural damage in patients with rheumatoid arthritis and an inadequate response to methotrexate: the ASSET randomised controlled trial
- Author
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Anca I. Catrina, Philip G. Conaghan, Lars Klareskog, Gerd-Rüdiger Burmester, Charles Peterfy, Julie C DiCarlo, Patrick Durez, Paul P. Tak, Rieke Alten, Xianhuang Zhou, Corine Gaillez, Manuela Le Bars, Clinical Immunology and Rheumatology, UCL - SSS/IREC/RUMA - Pôle de Pathologies rhumatismales, and UCL - (SLuc) Service de rhumatologie
- Subjects
Male ,Wrist Joint ,musculoskeletal diseases ,medicine.medical_specialty ,Immunoconjugates ,Immunology ,Drug Resistance ,Rheumatoid Arthritis ,Placebo ,General Biochemistry, Genetics and Molecular Biology ,law.invention ,Abatacept ,Arthritis, Rheumatoid ,Double-Blind Method ,Rheumatology ,Randomized controlled trial ,law ,Internal medicine ,Synovitis ,medicine ,Clinical endpoint ,Humans ,Immunology and Allergy ,Disease Activity ,Osteitis ,T Cells ,Drug Substitution ,business.industry ,Clinical and Epidemiological Research ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,Surgery ,Clinical trial ,Methotrexate ,Treatment Outcome ,Antirheumatic Agents ,Rheumatoid arthritis ,Injections, Intravenous ,Drug Therapy, Combination ,Female ,business ,medicine.drug - Abstract
OBJECTIVES: This randomised, double-blind, placebo-controlled phase IIIb study evaluated the impact of abatacept on MRI pathology as a primary outcome in methotrexate (MTX)-refractory patients with rheumatoid arthritis. METHODS: Patients received intravenous abatacept (∼10 mg/kg) or placebo, on background MTX, for 4 months, followed by an 8-month open-label extension (OLE; all patients received abatacept plus MTX). Patients had 1.5T MRI with intravenous contrast at baseline, Months 4 and 12; wrist synovitis (three locations assessed), and wrist and hand (15 and eight locations assessed, respectively) osteitis and erosion were scored using OMERACT-RAMRIS. RESULTS: 26/27 abatacept- and 23/23 placebo-randomised patients completed Month 4 and entered the OLE; 26 and 21 completed Month 12. The primary endpoint was not achieved; mean change (SD) from baseline in synovitis was -0.44 (1.47) for abatacept versus 0.52 (1.38) for placebo (p=0.103) at Month 4. For mean change in synovitis adjusted for baseline score (sensitivity analysis), the difference between groups was -0.69, p=0.078. Adjusted mean changes (SE) in osteitis and erosion were -1.94 (0.86) and 0.45 (0.43) for abatacept, and 1.54 (0.90) and 0.95 (0.45) for placebo. Further MRI improvements were observed up to Month 12 for abatacept and from Months 4 to 12 for placebo-treated patients switched to abatacept at Month 4. Clinical efficacy was shown with abatacept and sustained to Month 12. CONCLUSIONS: Despite small patient numbers, MRI detected structural and synovial benefit, sustained to Month 12 in abatacept+MTX-treated patients, and improvements in structural and inflammatory outcomes for placebo+MTX-treated patients following addition of abatacept. CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov NCT00420199.
- Published
- 2013