Retention of subcutaneous abatacept for the treatment of rheumatoid arthritis: real-world results from the ASCORE study: an international 2-year observational study

Abstract

Objectives To evaluate retention, efficacy, and safety of subcutaneous (SC) abatacept over 2 years in patients with moderate-to-severe RA in the Abatacept SubCutaneOus in Routine clinical practicE (ASCORE) study. Methods Patients with RA who initiated SC abatacept 125 mg once weekly were enrolled in the international, observational, prospective multicentre ASCORE study into biologic-naïve or ≥ 1 prior biologic failure cohorts. Primary endpoint: abatacept retention rate at 2 years. Secondary endpoints: proportion of patients with good/moderate EULAR response rates based on DAS28 (ESR), low disease activity and/or remission according to DAS28 (ESR; ≤ 3.2/ < 2.6), SDAI (≤ 11/ ≤ 3.3), CDAI (≤ 10/ ≤ 2.8), and Boolean criteria. Retention rate by baseline serostatus was evaluated post hoc. Results Overall, 47% of patients remained on abatacept for 2 years, irrespective of treatment line. Higher abatacept retention rates were associated with lower prior biologic exposure. Generally, clinical outcomes showed that the proportion of patients with low disease activity/remission was higher in biologic-naïve patients (vs biologic-failure) and similar in those with 1 and ≥ 2 prior biologic failures. In patients on treatment at 2 years, good/moderate EULAR response rates of ~ 80% were consistently noted irrespective of prior biologic exposure. Across treatment lines, retention was greater in patients with seropositive (vs seronegative) RA. Patients with rheumatoid factor/anti-citrullinated protein antibody single-positive RA who were bio-naïve had higher retention than patients who were bio-experienced. Conclusions In the ASCORE study, SC abatacept retention was 47% at 2 years with good clinical outcomes and was well-tolerated in the real-world setting. Abatacept retention and clinical response rates were higher in patients who received abatacept as an earlier- versus later-line biologic drug treatment and in those with seropositive RA. Trial registration ClinicalTrials.gov, NCT02090556.

Real‐World Treatment Effectiveness of Disease‐Modifying Antirheumatic Drugs by Serostatus Among Patients With Rheumatoid Arthritis

“…It is noteworthy that multiple studies support the finding that abatacept is associated with a better treatment response/retention rate among the seropositive RA group (13,17,18,29). Such association is biologically plausible given the mechanism of action of abatacept.…”

“…These agents were less studied than TNFi and abatacept possibly because of insufficient data. To date, only little conflicting real‐world evidence is available for comparative effectiveness of tocilizumab in seropositive versus seronegative RA subtypes ( 29 , 30 ). Our study filled in the knowledge gap by including currently available IL‐6 inhibitors (tocilizumab and sarilumab) as well as JAKi (tofacitinib, baricitinib, and upadacitinib).…”

Seronegative rheumatoid arthritis: one year in review 2023

“…(82) showed prolonged retention rate in RA patients treated with rituximab, but only in the presence of autoantibodies. Alten et al (86) reported long-term retention rate of subcutaneous abatacept in RA patients from the Abatacept Sub-CutaneOus in Routine clinical practice (ASCORE) prospective multicenter trial. Among 2892 studied patients, 47% was still on abatacept therapy at 2 years.…”

Rheumatoid arthritis as a clinical and immunological syndrome: focus on the seronegative subtype of the disease

“…Анти-В-клеточная терапия с использованием моноклональных антител к CD20 (ритуксимаб) более эффективна у серопозитивных, чем у серонегативных пациентов с РА [114][115][116][117]. Сходные данные получены в отношении абатацепта (блокатор ко-стимуляции Т-клеток) [118][119][120]. Связи между эффективностью терапии ингибиторами ИЛ-6 (тоцилизумаб) и серопозитивностью по РФ/АЦЦП не выявлено [120].…”