In a nutshell
This study explored the use of abatacept (ABT, Orencia) with either methotrexate (MTX, Trexall) or tacrolimus (TAC) in rheumatoid arthritis patients who had not responded well to previous drugs. The study concluded that ABT and TAC together showed the best response and could be used together to treat rheumatoid arthritis after other drugs had failed.
Some background
Rheumatoid arthritis is an autoimmune disease, where the immune system attacks healthy joint tissue the way it would a virus or bacteria. ABT is a treatment that blocks the immune response. It has been shown to be a safe and effective drug in treating rheumatoid arthritis. It has been used typically as a second choice drug when other drugs have failed. It is unclear whether it is effective on its own. Using ABT combined with other drugs, such as methotrexate, may increase its effectiveness.
TAC has been used to treat rheumatoid arthritis patients who did not respond to other drugs. It also suppresses the immune system. Whether TAC and ABT together would be more effective than ABT alone is unclear.
Methods & findings
This study compared the effectiveness of ABT combined with either MTX or TAC.
This study included 116 patients. 42 were treated with ABT on its own. 56 were treated with ABT with MTX. 18 were treated with ABT with TAC.
Disease activity (pain and swelling in the joints) reduced from week 4 and was maintained up to 1 year in all groups. The ABT-TAC group showed the greatest average reduction in disease activity. 38.9% of ABT-TAC patients achieved low disease activity at 1 year. 20% of ABT-MTX patients achieved low disease activity at 1 year.
There was a 25% difference in outcomes between ABT and ABT-TAC groups. There was no significant difference between the ABT and the ABT-MTX groups. The higher-dose TAC group (more than 2.5 mg/day) showed a better outcome than the lower dose TAC group (less than 2.5 mg/day).
The bottom line
The study concluded that the combination of ABT-TAC was more effective than a combination of ABT-MTX in rheumatoid arthritis patients who have not responded to previous biological DMARDs.
The fine print
ABT and TAC suppress the immune system, so there is a risk of infection.
What’s next?
Discuss with your doctor which treatment combination is right for you.
Published By :
Rheumatology International
Date :
May 20, 2015
