Abatacept, adalimumab yield ‘identical’ responses in early rheumatoid arthritis
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WASHINGTON — Patients in early rheumatoid arthritis respond well to either abatacept or adalimumab, with the critical factor for both treatments being prompt initiation, according to data presented at ACR Convergence 2024.
“Achieving optimum results in patients with rheumatoid arthritis obviously requires accurate prediction of DMARD response,” Michael Weinblatt, MD, of Brigham and Women's Hospital and Harvard Medical School, told attendees. “To date, we have very few serological parameters that can accurately predict response to our drug therapies.”
Weinblatt highlighted previous data attempting to compare responses to abatacept (Orencia, Bristol Myers Squibb) and adalimumab (Humira, Abbvie) in RA as a function of anti-citrullinated protein antibodies and rheumatoid factor.
To test the hypothesis that patients with early RA and an incomplete response to methotrexate, and who were dual positive for rheumatoid factor and cyclic citrullinated peptide (CCP), and demonstrated a shared epitope, would have a superior response to abatacept (Orencia, Bristol Myers Squibb) vs. adalimumab (Humira, AbbVie), Weinblatt and colleagues conducted the AMPLIFIED trial. This phase 3, randomized, single-blind study included 169 patients treated with 125 mg abatacept weekly plus methotrexate, and 169 patients treated with 40 mg adalimumab every 2 weeks plus methotrexate.
Eligible participants had a disease duration of less than 12 months and were naive to biologics and targeted DMARD therapies.
“This is early rheumatoid arthritis,” Weinblatt said.
The cohort was more than 80% women from North and South America, Europe and Asia. The primary endpoint was ACR50 response.
“The study was powered to show that abatacept was superior to adalimumab at 24 weeks,” Weinblatt said.
According to the researchers, the study failed to meet its primary endpoint. ACR50 response rates were 59% for abatacept and 60.3% for adalimumab.
“The lines are basically right on top of each other throughout the study duration,” Weinblatt said. “The kinetics of response were similar in both treatment groups.”
Similar outcomes for abatacept and adalimumab were observed for ACR20 and ACR70 response, as well.
“Both were very, very impressive as far as efficacy,” Weinblatt said.
Meanwhile, patient-reported outcomes paralleled ACR50 response, according to Weinblatt.
“There were impressive reductions in patient assessment of pain,” he said.
Health Assessment Questionnaire Disability Index, Patient Global Assessment outcomes, Short Form 36 response, fatigue and morning stiffness were “all identical” for the two study drugs, Weinblatt added. Absenteeism, work productivity and activity impairment outcomes were also similar for abatacept and adalimumab.
“Why this occurred is uncertain,” Weinblatt said.
Despite the failure to meet the primary endpoint, Weinblatt believes there is a key message to be taken from these findings.
“Most patients with early rheumatoid arthritis responded well to both drugs,” he said. “If you really want to get a response in rheumatoid arthritis, start them on a therapy early.”
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Weinblatt M. Abstract #2671. Presented at: ACR Convergence 2024; Nov. 14-19, 2024; Washington, D.C.
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