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

UMMS Affiliation

Department of Orthopedics and Physical Rehabilitation

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Document Type



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

Journal/Book/Conference Title

The Journal of rheumatology

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