Abatacept – what is the safety profile in rheumatoid arthritis treatment?

In a nutshell
This study investigated the safety of abatacept (Orencia) compared to other disease-modifying anti-rheumatic drugs (DMARDs).  They found that this treatment was well tolerated and had a similar safety profile to other DMARDs.

Some background

Rheumatoid arthritis (RA) is a chronic condition. It is caused by painful swelling and inflammation in the joints. RA is treated with drugs that reduce inflammation. These drugs are called disease-modifying anti-rheumatic drugs (DMARDs). Synthetic DMARDs (csDMARDs) are chemical drugs. Biological DMARDs (bDMARDs) are drugs that bind and neutralize inflammatory proteins. Patients are usually treated with bDMARDs if they have a poor response to csDMARDs.  Abatacept (ABT) is a bDMARD. It inhibits tumor necrosis factor (TNF). TNF is a strong stimulator of inflammation. ABT has been used to treat RA for many years. Despite this, the long-term safety of treatment has not been fully assessed. It is unclear if the rate or profile of side effects is different after long-term use.

Methods & findings

This study included 1496 patients with RA treated with ABT. It also included 3490 patients treated with another bDMARD and 1520 patients treated with csDMARDs. The average follow-up time was 2-2.5 years. The authors compared the safety data. This included the rates of cancer, infections, and death. There was no difference in the rates of cancer in ABT-treated patients compared to other drugs. Breast, lung cancer or lymphoma was not observed in any patients. The risk of these cancers could not be calculated. ABT treatment was associated with a lower risk of hospitalization of infections. There was a slightly increased risk of psoriasis in ABT-treated patients. Death rates were similar across the groups. 

The bottom line

The authors concluded that ABT was well tolerated and had a similar safety profile to other DMARDs.The fine printThe number of side effects in this patient-group was low. This made it difficult to calculate the risk of some events. Some outcomes were self-reported. This means that some events could be overlooked. More investigation is needed.  

Source: Here