Among Various Biologics, Abatacept Stands Out vs Conventional Treatment for RA

Following a study that compared the effects of conventional treatment against 3 different biologics for rheumatoid arthritis (RA), researchers have concluded that all 4 treatments are effective and safe options for the condition while also highlighting the remission rates of 1 of these treatments in particular. Their findings were published in The BMJ.

Each of the treatments resulted in high remission rates at 24 weeks among the 800 treatment-naïve patients included in the study. Forty percent of the patients achieved the goal after receiving treatment with certolizumab pegol, abatacept, or tocilizumab, all given in combination with methotrexate.

“The optimal first-line treatment for patients with early rheumatoid arthritis has been debated, especially whether it should include a biological disease-modifying drug,” wrote the researchers. “Currently, treatment recommendations in Europe and the United States advocate early treatment with conventional slow-acting synthetic disease-modifying drugs, with methotrexate as the anchor drug.”

The 3 biological disease-modifying drugs assessed in this trial offer different mechanisms of action for treating RA. Certolizumab pegol is a tumor necrosis factor inhibitor, abatacept is a T-cell costimulation blocker, and tocilizumab is an interleukin-6 inhibitor.

Throughout the phase 4 study, comparable rates were observed among the patients taking conventional treatment, which consisted of methotrexate combined with corticosteroids. Some patients also received sulfasalazine and hydroxychloroquine.

Abatacept, in particular, was shown to have a 9% increase in likelihood of achieving remission compared with conventional treatment, which the researchers contribute to the treatment’s lower discontinuation rates. The same was not seen for the other 3 therapies, with the researchers noting that they had similar remission rates and that noninferiority analysis showed the conventional treatment was noninferior to certolizumab pegol and tocilizumab.

“For all key secondary outcomes, including longitudinal analysis and a range of other remission and response criteria, the overall differences between treatments were modest with overlapping confidence intervals,” wrote the researchers.

Adverse events were reported in 86.3% of patients receiving conventional treatment, 82.7% receiving certolizumab pegol, 79.9% receiving abatacept, and 95.1% receiving tocilizumab. Serious adverse events were reported in 5.6%, 8.4%, 4.9%, and 4.9% of patients, respectively.

“The results highlight the efficacy and safety of active conventional treatment based on methotrexate combined with corticosteroids, with nominally better results for abatacept, in treatment naive early rheumatoid arthritis,” the authors concluded.

Reference

Hetland ML, Haavardsholm EA, Rudin A, et al. Active conventional treatment and three different biological treatments in early rheumatoid arthritis: phase IV investigator initiated, randomised, observer blinded clinical trial. BMJ. Published online December 2, 2020. doi: 10.1136/bmj.m4328