Abatacept, certolizumab pegol superior to conventional therapy for rheumatoid arthritis
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Key takeaways:
- Patients with rheumatoid arthritis who received abatacept or certolizumab pegol were more likely to achieve remission.
- Secondary outcomes were improved in groups receiving biologic therapies.
Patients with rheumatoid arthritis who receive abatacept or certolizumab pegol achieve clinical remission at higher rates than those receiving active conventional therapy, according to data published in Annals of the Rheumatic Diseases.
“The optimal first-line treatment of patients with early RA is debated,” Mikkel Østergaard, MD, PhD, DMSc, of the Copenhagen Center for Arthritis Research, and colleagues wrote. “Several trials have shown superior outcomes in treatment-naïve patients treated with biological disease-modifying antirheumatic drugs (bDMARDs) in combination with methotrexate (MTX) compared with MTX monotherapy.”
To investigate the impact of specific biologic therapies on patients with early RA, Østergaard and colleagues conducted a randomized, blinded study of adults aged 18 years or older who had a symptom duration of fewer than 24 months, were DMARD-naïve, had a moderate to severe disease activity score and two or more tender or swollen joints. Following enrollment, patients were divided based on country, gender and anticitrullinated protein antibody positivity (ACPA) status.
Participants were randomized 1:1:1:1. All patients received background therapy in the form of methotrexate, while the active conventional therapy group received oral prednisolone, which was quickly tapered, or sulphasalazine in combination with hydroxychloroquine and intra-articular triamcinolone hexacetonide injections. The second group received certolizumab pegol (Cimzia, UCB), while the third group received abatacept (Orencia, Bristol Myers Squibb). The fourth group received tocilizumab (Actemra, Genentech).
The study featured two primary outcomes — achievement of clinical remission at 48 weeks and change in radiographic scores from baseline through 48 weeks.
In all, the analysis included 812 patients. Following adjustment, remission rates achieved by each group at week 48 were 59.3% for abatacept, 52.3% for certolizumab pegol, 51.9% for tocilizumab and 39.2% for active conventional therapy. Compared with the active conventional therapy group, patients receiving abatacept (P < .001) and certolizumab (P = .021) — but not tocilizumab (P = .03) — were statistically significantly more likely to achieve remission, according to the researchers. Additionally, key secondary outcomes of interest were “consistently better” in groups that received biologic therapy, they wrote.
“This large investigator-initiated, randomized controlled trial showed a marked clinical superiority for two of the three biologicals in this study, compared with active conventional therapy including MTX and glucocorticoids,” Østergaard and colleagues wrote. “We believe that the fact that two therapies (abatacept and certolizumab pegol) provide clinically and statistically significantly higher remission rates as compared with optimized conventional antirheumatic therapy with bridging glucocorticoids should be considered when the management of patients with newly diagnosed RA is decided, both in clinical practice and in treatment recommendations.”
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