Conversion to seronegative status after abatacept treatment in patients with early and poor prognostic rheumatoid arthritis is associated with better radiographic outcomes and sustained remission: post hoc analysis of the AGREE study
Conversion to seronegative status after abatacept treatment in patients with early and poor prognostic rheumatoid arthritis is associated with better radiographic outcomes and sustained remission: post hoc analysis of the AGREE study
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DOI：
10.1136/rmdopen-2017-000564
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发表时间：
2018-02-01
期刊：
影响因子：
6.2
通讯作者：
Huizinga, Tom W. J.
中科院分区：
文献类型：
--
作者：
Jansen, Diahann T. S. L.;Emery, Paul;Huizinga, Tom W. J.
目的评价T细胞共刺激阻断剂阿巴西普对抗瓜氨酸蛋白抗体（ACPA）和类风湿因子（RF）在早期类风湿关节炎（RA）中的作用，以及血清学状态变化与临床反应的相关性。患者被随机分配到阿巴西普（根据体重范围，静脉注射10 mg/kg）或安慰剂，加MTX超过12个月，然后是开放标签阿巴西普加MTX 12个月。在基线和第6个月和第12个月（双盲期）通过ELISA测定自身抗体滴度。结果阿巴西普联合MTX组ACPA（RF）滴度下降幅度大于MTX组，ACPA和RF转阴率均高于MTX组。根据28个关节的疾病活动性评分（C-反应蛋白）或临床疾病活动性指数，接受阿巴西普加MTX治疗的ACPA血清阴性状态转化为ACPA血清阴性状态的患者比保持ACPA血清阳性的患者更多。转换为ACPA血清阴性状态的患者与阿巴西普加MTX治疗有更大的概率实现持续缓解和放射学进展比MTX单独或患者谁仍然ACPA血清阳性（无论是治疗）。结论阿巴西普加MTX治疗更有可能诱导转换为ACPA/RF血清阴性状态的患者早期，糜烂性RA。转为ACPA血清阴性状态与更好的临床和影像学结局相关。
Objective To evaluate the effects of the T-cell costimulation blocker abatacept on anti-citrullinated protein antibodies (ACPA) and rheumatoid factor (RF) in early rheumatoid arthritis (RA), and associations between changes in serological status and clinical response.Methods Post hoc analysis of the phase III AGREE study in methotrexate (MTX)-naive patients with early RA and poor prognostic factors. Patients were randomised to abatacept (similar to 10 mg/kg intravenously according to weight range) or placebo, plus MTX over 12 months followed by open-label abatacept plus MTX for 12 months. Autoantibody titres were determined by ELISA at baseline and months 6 and 12 (double-blind phase). Conversion to seronegative status and its association with clinical response were assessed at months 6 and 12.Results Abatacept plus MTX was associated with a greater decrease in ACPA (but not RF) titres and higher rates of both ACPA and RF conversion to seronegative status versus MTX alone. More patients converting to ACPA seronegative status receiving abatacept plus MTX achieved remission according to Disease Activity Score in 28 joints (C-reactive protein) or Clinical Disease Activity Index than patients who remained ACPA seropositive. Patients who converted to ACPA seronegative status treated with abatacept plus MTX had a greater probability of achieving sustained remission and less radiographic progression than MTX alone or patients who remained ACPA seropositive (either treatment).Conclusions Treatment with abatacept plus MTX was more likely to induce conversion to ACPA/RF seronegative status in patients with early, erosive RA. Conversion to ACPA seronegative status was associated with better clinical and radiographic outcomes.