Effect of Anticitrullinated Protein Antibody Status on Response to Abatacept or Antitumor Necrosis Factor-alpha Therapy in Patients with Rheumatoid Arthritis: A US National Observational Study
Department of Orthopedics and Physical Rehabilitation
Immune System Diseases | Musculoskeletal Diseases | Rheumatology | Skin and Connective Tissue Diseases | Therapeutics
OBJECTIVE: Assess whether baseline anticyclic citrullinated peptide antibodies (anti-CCP) status is associated with treatment response in patients with rheumatoid arthritis (RA) initiating abatacept (ABA) or a tumor necrosis factor-alpha inhibitor (TNFi).
METHODS: Using the Corrona RA registry, patients were identified who initiated ABA or a TNFi (June 2004-January 2015), had a followup visit 6 months (+/- 3 mos) after initiation, and anti-CCP measured at or prior to initiation. Primary outcome was mean change in Clinical Disease Activity Index (CDAI) from initiation to 6 months. Treatment response was evaluated based on a typical patient profile (female, aged 57 yrs, body mass index of 30 kg/m(2), baseline CDAI of 20, 1 prior biologic, and no comorbidities other than RA). Secondary outcomes included remission and low disease activity.
RESULTS: There were 566 ABA initiators [anti-CCP+ ( > /= 20 units/ml): n = 362; anti-CCP- ( < 20 units/ml): n = 204] and 1715 TNFi initiators (anti-CCP+: n = 1113; anti-CCP-: n = 602). Differences between treatment groups included baseline disease duration, CDAI, and prior biologic use. At 6 months, anti-CCP+ ABA initiators were associated with significantly greater CDAI response versus anti-CCP- ABA initiators; no significant difference was observed for TNFi initiators. When considering a typical RA patient profile, CDAI response was greater in anti-CCP+ versus anti-CCP- ABA initiators; anti-CCP+ versus anti-CCP- TNFi initiators were similar. Secondary outcome responses were also greater in anti-CCP+ versus anti-CCP- ABA initiators; TNFi initiators did not differ by anti-CCP status.
CONCLUSION: In a US-based clinical practice setting, anti-CCP status was associated with a differential treatment response to ABA, but not TNFi.
anti-tumor necrosis factor, anticyclic citrullinated antibodies, disease-modifying antirheumatic drugs, rheumatoid arthritis
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© 2018. Free online via JRheum Full Release option.
DOI of Published Version
J Rheumatol. 2018 Jan;45(1):32-39. doi: 10.3899/jrheum.170007. Epub 2017 Nov 1. Link to article on publisher's site
The Journal of rheumatology
Harrold LR, Litman HJ, Connolly SE, Kelly S, Hua W, Alemao E, Rosenblatt L, Rebello S, Kremer JM. (2018). Effect of Anticitrullinated Protein Antibody Status on Response to Abatacept or Antitumor Necrosis Factor-alpha Therapy in Patients with Rheumatoid Arthritis: A US National Observational Study. Open Access Articles. https://doi.org/10.3899/jrheum.170007. Retrieved from https://escholarship.umassmed.edu/oapubs/3300