Can the dose of abatacept (Orencia) be reduced in rheumatoid arthritis patients who are in remission?

This study evaluated the impact of reducing the dose of abatacept (Orencia) in patients who were no longer showing any signs or symptoms of rheumatoid arthritis.

Treatments for rheumatoid arthritis aim to reduce or end signs and symptoms of the disease (remission). This in turn helps prevent further joint damage and disability. The main drugs for treating patients are disease-modifying antirheumatic drugs (DMARDs; for example Rheumatrex, Azulfidine, Plaquenil). The most common DMARD and preferred initial treatment is methotrexate (Rheumatrex, Trexall).

A range of other biologic drugs (drugs extracted from biological sources, for example human cells or genes) also exist. Abatacept is a biologic drug currently approved for use in patients who have not improved after at least one other DMARD. However, whether the dose of abatacept can safely be lowered once patients are in remission is unknown.

This study was the second phase of a larger trial investigating abatacept use in patients with high disease activity and poor prognosis. In the first phase of the study patients were treated with around 10 mg/kg of abatacept plus methotrexate for 2 years. 108 patients in remission continued on to this second phase of the study. Patients were randomly assigned to continue taking 10 mg/kg of abatacept or to decrease the dose to 5 mg/kg for 12 months.

The rate of patient relapse was similar for both groups, 31% of patients who took 10 mg/kg and 34% of patients who took 5 mg/kg. 

A similar number of patients stopped the treatment in both groups. 3 patients (5.1%) taking 10 mg/kg and 5 (10%) patients taking 5 mg/kg stopped taking abatacept. 4 patients from both groups continued taking abatacept but at a different dose. 3.4% of patients who took 10 mg/kg and 12% of patients who took 5 mg/kg began treatment with another DMARD.  

This study suggests that reducing the dose of abatacept is safe and may be an option in this specific patient group.

This study was funded by Bristol-Myers Squibb who also developed the drug abatacept. 

If you have any questions regarding decreasing the dose of medication you are taking please consult with your doctor.