Difficult-to-treat rheumatoid arthritis treated with Abatacept combined with Baricitinib: A case report

Abstract

BACKGROUND Sporadic cases of rheumatoid arthritis (RA) due to unsatisfactory responses to Abatacept (ABT) have been reported; however, the rescue therapy has not been finalized. Here, we present a case with difficult-to-treat RA (D2T RA) that was resistant to either a single ABT or a Janus kinase (JAK) inhibitor (Tofacitinib), but improved with a combination of ABT and JAK inhibitor (Baricitinib, BAT). CASE SUMMARY A 46-year-old Chinese woman who had RA for ten years that was resistant to Tocilizumab, Etanercept, Adalimumab, and ABT. According to the European League Against Rheumatism definition, the patient was diagnosed with D2T RA. It was then improved with a combination of ABT and a JAK inhibitor BAT. CONCLUSION ABT combined with BAT may be an acceptable strategy for treating D2T RA.

The effect of abatacept on T-cell activation is not long-lived in vivo

“…In a model of type 1 diabetes, abatacept treatment combined with IL-2 administration had the beneficial effect of restoring regulatory T-cell homeostasis [ 10 ]. Although the combination of Janus kinase (Jak) inhibitors and abatacept is not usually recommended, there are already case observations of difficult-to-treat patients with RA where they were more effective together than as a monotherapy [ 28 ]. Future studies will be important to elucidate whether the combination of abatacept with other drugs could not only improve its efficacy but also the effect duration.…”