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Decrease in Corticosteroid Use in Patients with Rheumatoid Arthritis Who Initiated Intravenous Abatacept Treatment: Results From the 2-Year ACTION Study
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Veröffentlicht: | 4. September 2017 |
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Background: ACTION (AbataCepT In rOutiNe clinical practice; NCT02109666) is a prospective, real-world study of patients with RA. Important concomitant treatment options for patients with RA include low-dose corticosteroids; however, corticosteroid dose should be tapered as soon as clinically feasible to reduce any safety concerns from continued use [1]. Decreased use of glucocorticoids has been previously reported for biologic-experienced patients who initiated abatacept [2]. We examined the use of concomitant corticosteroids in both biologic-naïve and biologic-experienced patients initiating abatacept.
Methods: ACTION is a 2-year, observational study of biologic-naïve and biologic-experienced patients with moderate-to-severe RA who initiated IV abatacept in routine clinical practice in Europe and Canada between May 2008 and December 2013. Concomitant corticosteroid use in patients initiating abatacept was analysed over 2 years. Corticosteroid doses were assessed using median area under the concentration–time curve (mg/day).
Results: A total of 2350/2364 patients (99.4%) were evaluable for the 2-year analysis; 673 (28.6%) were biologic naïve and 1677 (71.4%) biologic experienced. Of the biologic-experienced patients, 729 (43.4%) had received 1 and 948 (56.6%) had received ≥2 previous biologics. For biologic-naïve and biologic-experienced patients, respectively: mean (SD) age: 59.9 (12.7) and 56.9 (12.5) years; 496 (73.7%) and 1379 (82.2%) were women; RA duration: 7.2 (8.2) and 12.1 (9.1) years; baseline DAS28 (CRP): 4.8 and 5.0; and 621 (92.3%) and 1552 (92.5%) had previously received MTX. At abatacept initiation, concomitant corticosteroids were used in 455/673 (67.6%) biologic-naïve patients at a median dose of 5.0 mg/day and in 1190/1677 (71.0%) biologic-experienced patients at a median dose of 7.5 mg/day. At 2 years, the percentage of patients using corticosteroids decreased in both biologic-naïve and biologic-experienced cohorts (67.6 to 49.3% and 71.0 to 56.6%), respectively, and the median corticosteroid dose decreased to 6.0 mg/day in the biologic-experienced patients (Figure 1 [Fig. 1]). Of the 850 patients still on-study at 2 years with corticosteroid use data (286 biologic naïve, 564 biologic experienced), 197 biologic-naïve and 403 biologic-experienced patients had been taking corticosteroids at baseline, of whom 62 (31.5%) and 108 (26.8%), respectively, had stopped at 2 years.
Conclusion: This analysis showed a reduction in concomitant corticosteroid use in both biologic-naïve and biologic-experience patients with RA treated with abatacept, and that complete cessation of corticosteroids is possible in almost one-third of patients.