Abatacept in pre-RA

Team: Abatacept for pre-RA, aka the “tendon ticklers”

Base article: Cope AP, Jasenecova M, Vasconcelos JC, Filer A, Raza K, Qureshi S, D’Agostino MA, McInnes IB, Isaacs JD, Pratt AG, Fisher BA, Buckley CD, Emery P, Ho P, Buch MH, Ciurtin C, van Schaardenburg D, Huizinga T, Toes R, Georgiou E, Kelly J, Murphy C, Prevost AT; APIPPRA study investigators. Abatacept in individuals at high risk of rheumatoid arthritis (APIPPRA): a randomised, double-blind, multicentre, parallel, placebo-controlled, phase 2b clinical trial. Lancet. 2024 Mar 2;403(10429):838-849. doi: 10.1016/S0140-6736(23)02649-1. Epub 2024 Feb 13. PMID: 38364839.

Authors: Allegheny Health Network Adult Rheumatology Fellowship

  1. Conor O’Donnell, DO, Second year rheumatology fellow
  2. Saloni Goyal, DO, Second year rheumatology fellow
  3. Guru Prasad Parthiban, MD, First year rheumatology fellow
  4. Mara Banez, MD, First year rheumatology fellow
  5. Michael Lucke, MD, Program Director

Team Overview: 

Imagine your patient squaring off on the baseball diamond in the immunologic ballpark. Rheumatoid Arthritis (RA) is the pitcher and is ready to throw a citrullinated fast ball at your patient. Would you rather risk the long-term consequences of a strikeout, or give them the resources to prevent RA’s tendrils from infiltrating their pristine joint space? The APIPPRA trial showed that abatacept’s protective gear could stave off the inflammatory advances of rheumatoid arthritis.

This groundbreaking trial was the first of its kind to demonstrate a sustained delay in the development of RA and onset of clinical synovitis. In this multicenter placebo controlled clinical trial, abatacept showed improvement in pain scores, functional well-being, quality of life and subclinical synovitis at one year.

At 12 months, 29% of patients on placebo had development of clinical synovitis or progression to RA compared to 6% of patients on abatacept. Despite discontinuation of the abatacept in the treatment arm at 12 months, this difference was sustained at 24 months, with 38% in the placebo group compared to 25% in the abatacept group. There was no increase in side effects in the abatacept group compared to placebo.

Abatacept was a home run in potentially delaying the transition from pre-clinical RA to clinical RA, suggesting it may alter the risk state of pre-clinical RA. This low-risk, high-reward tool will empower your patient to seize victory in the battle against rheumatoid arthritis.

Related content on theMednet.org:

What is your approach to monitoring patients referred for high titer +RF and +CCP but without active symptoms of inflammatory arthritis?

 

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