Benefits of Autoantibody Enrichment in Early Rheumatoid Arthritis: Analysis of Efficacy Outcomes in Four Pooled Abatacept Trials

Kaleb Michaud; Philip G Conaghan; Sang Hee Park; Karissa Lozenski; Mirko Fillbrunn; Vadim Khaychuk; Elyse Swallow; John Vaile; Henry Lane; Ha Nguyen; Janet Pope

doi:10.1007/s40744-023-00552-2

Benefits of Autoantibody Enrichment in Early Rheumatoid Arthritis: Analysis of Efficacy Outcomes in Four Pooled Abatacept Trials

Rheumatol Ther. 2023 Aug;10(4):951-967. doi: 10.1007/s40744-023-00552-2. Epub 2023 May 25.

Authors

Kaleb Michaud^#^{1

2}, Philip G Conaghan^#³, Sang Hee Park^{4

5}, Karissa Lozenski⁶, Mirko Fillbrunn⁷, Vadim Khaychuk⁶, Elyse Swallow⁷, John Vaile⁶, Henry Lane⁷, Ha Nguyen⁷, Janet Pope⁸

Affiliations

¹ University of Nebraska Medical Center, Omaha, NE, USA.
² FORWARD, The National Databank for Rheumatic Diseases, Wichita, KS, USA.
³ Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Biomedical Research Centre, Leeds, UK.
⁴ Bristol Myers Squibb, Princeton, NJ, USA. sarah.park@bms.com.
⁵ Bristol Myers Squibb, 3401 Princeton Pike, Lawrenceville, NJ, 08648, USA. sarah.park@bms.com.
⁶ Bristol Myers Squibb, Princeton, NJ, USA.
⁷ Analysis Group, Inc., Boston, MA, USA.
⁸ Schulich School of Medicine, Western University, London, ON, Canada.

^# Contributed equally.

Abstract

Introduction: The efficacy of abatacept is enhanced in anti-citrullinated protein antibody (ACPA) and rheumatoid factor (RF)-positive versus -negative patients with rheumatoid arthritis (RA). Four early RA abatacept trials were analyzed to understand the differential impact of abatacept among patients with SeroPositive Early and Active RA (SPEAR) compared to non-SPEAR patients.

Methods: Pooled patient-level data from AGREE, AMPLE, AVERT, and AVERT-2 were analyzed. Patients were classified as SPEAR if they were ACPA +, RF +, disease duration < 1 year, and Disease Activity Score-28 (DAS28) C-reactive protein (CRP) ≥ 3.2 at baseline; non-SPEAR otherwise. Outcomes included: American College of Rheumatology (ACR) 20/50/70 at week 24; mean change from baseline to week 24 for DAS28 (CRP), Simple Disease Activity Index (SDAI), ACR core components; DAS28 (CRP) and SDAI remission. Adjusted regression analyses among abatacept-treated patients compared SPEAR and non-SPEAR patients, and in full trial population estimating how the efficacy of abatacept versus comparators [adalimumab + methotrexate, methotrexate] was modified by SPEAR status.

Results: The study included 1400 SPEAR and 673 non-SPEAR patients; most were female (79.35%), white (77.38%), and with a mean age 49.26 (SD 12.86) years old. Around half with non-SPEAR were RF + and three-quarters ACPA +. Stronger improvements from baseline to week 24 were observed in almost all outcomes for abatacept-treated SPEAR versus non-SPEAR patients or versus SPEAR patients treated with comparators. Larger improvements were observed for SPEAR patients among the abatacept-treated population, and more strongly improved efficacy among SPEAR patients for abatacept than comparators.

Conclusions: This analysis, including large patient numbers of early-RA abatacept trials, confirmed beneficial treatment effects of abatacept in patients with SPEAR versus non-SPEAR.

Keywords: Abatacept; Anti-citrullinated protein antibody; Cross-trial analysis; Rheumatoid arthritis; Rheumatoid factor; Seropositive.