Positioning of Abatacept in the treatment of Rheumatoid Arthritis

Abstract

　Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized mainly by chromic joint inflammation. Many biological therapies for RA have become available during the past decade including TNF blockers, abatacept, or tocilizumab, making clinical remission an achievable goal. However, responsiveness to biological agents is variable among individuals, and there are poor responders to certain biological agents. Given the destructive nature of RA, the risk of adverse events, and the considerable costs of biologic therapy, there is a need to identify predictors of response to biologics. Abatacept (ABT) is a soluble human recombinant protein in which the extracellular domain of human cytotoxic T lymphocyte-associated molecule 4 is bound to the Fc portion of human IgG1. The safety and efficacy of ABT in patients with RA have been demonstrated in many worldwide studies for those who are methotrexate (MTX)-naïve, MTX-inadequate responders or anti TNF-α-inadequate responders.
　Consequently, the strategies for treatment of elderly patients with RA tend to focus more on safety when compared with younger patients. The aim of our present study was to identify the predictive factors associated with sustained clinical remission for biologic-naïve patients with RA and to compare them between elderly (≧65 yrs) and younger patients (≦65 yrs). We discuss the positioning of RA treatment of ABT compared with the other biologics such as anti-TNF-α inhibitor and tocilizumab.