Combining therapies for very early rheumatoid arthritis

This study examined the combination of abatacept (Orencia) with methotrexate (Trexall) in achieving and maintaining remission in patients with very early rheumatoid arthritis (RA). Researchers concluded that combination therapy is more effective than each treatment alone in achieving remission in very early RA.  

RA is a chronic autoimmune disease in which the immune system attacks healthy tissues. This can cause pain, stiffness, swelling and restricted movement in the joints. The first-line treatment for RA often involves methotrexate. Abatacept is a recently developed biological therapy. Abatacept works by blocking the immune response in order to prevent joint destruction. It is typically used as a second-choice drug when other therapies have failed. 

Early evidence suggests that combining abatacept and methotrexate can be more effective than either treatment alone. Whether combining abatacept with methotrexate is effective in patients with very early RA has not been fully studied.

The aim of this study was to evaluate combination therapy in patients with very early RA.

A total of 351 patients with very early RA were included in this study. Patients were randomly assigned to one of three treatment groups. 116 patients received abatacept alone (Group A). 116 patients received methotrexate alone (Group M). 119 patients received a combination of abatacept with methotrexate (Group AM). All treatments were administered for 12 months. Imaging of the wrist and hand was used to detect changes in inflammation. Treatment outcomes were followed for 6 months after the end of treatment.

The greatest decrease in bone and joint inflammation was observed in Group AM. Inflammation and disease progression in Group AM were significantly improved when compared to Group M. This improvement remained statistically significant 6 months after treatment. Treatment outcomes of Group A consistently lay in between the values of Group M and Group AM.

After 12 months, 49.6% of patients in Group AM achieved disease remission (no active disease) with no sign of joint inflammation on MRI, compared to 37.1% of Group A and 35.3% of Group M. 6 months after treatment, 15.1% of Group AM continued without evidence of joint inflammation, compared to 9.5% of Group A and 7.8% of Group M.

Researchers concluded that abatacept together with methotrexate is effective at reducing inflammation and disease progression in very early RA. These improvements are maintained in some patients even after withdrawing treatment.