gms | German Medical Science

45. Kongress der Deutschen Gesellschaft für Rheumatologie, 31. Jahrestagung der Deutschen Gesellschaft für Orthopädische Rheumatologie, 27. Jahrestagung der Gesellschaft für Kinder- und Jugendrheumatologie

06.09. - 09.09.2017, Stuttgart

Body Mass Index Does Not Influence the Efficacy of Abatacept in Patients With PsA: Results From the ASTRAEA Trial

Meeting Abstract

  • Iain McInnes - University of Glasgow, Glasgow, United Kingdom
  • Gianfranco Ferraccioli - Catholic University of the Sacred Heart, Rome, Italy
  • Maria Antonietta D'Agostino - Hôpital Ambroise Paré, Department of Rheumatology, Boulogne-Billancourt, France
  • Manuela Le Bars - Bristol-Myers Squibb, Rueil-Malmaison, France
  • S Banerjee - Bristol-Myers Squibb, Princeton, United States
  • HA Ahmad - Bristol-Myers Squibb, Princeton, United States
  • Yedid Elbez - Excelya, Boulogne-Billancourt, France
  • J Ye - Bristol-Myers Squibb, Princeton, United States
  • Philip Mease - Department of Rheumatology, Swedish Medical Center, and University of Washington, Seattle, WA, USA

Deutsche Gesellschaft für Rheumatologie. Deutsche Gesellschaft für Orthopädische Rheumatologie. Gesellschaft für Kinder- und Jugendrheumatologie. 45. Kongress der Deutschen Gesellschaft für Rheumatologie (DGRh), 31. Jahrestagung der Deutschen Gesellschaft für Orthopädische Rheumatologie (DGORh), 27. Jahrestagung der Gesellschaft für Kinder- und Jugendrheumatologie (GKJR). Stuttgart, 06.-09.09.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocSpA.06

doi: 10.3205/17dgrh206, urn:nbn:de:0183-17dgrh2063

Veröffentlicht: 4. September 2017

© 2017 McInnes et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Background: Obesity is a risk factor for the development and severity of psoriatic arthritis (PsA) [1], [2]. Patients with increased BMI are less likely to achieve sustained minimal disease activity (MDA) compared with those with normal BMI, independent of treatment [3]. Moreover, obese patients with PsA respond less favourably to TNFα inhibitors than those with normal BMI [4], [5]. In the Phase III ASTRAEA trial (NCT01860976) [6], abatacept significantly improved disease activity and was well tolerated; the primary endpoint of ACR20 at 24 weeks (W) was met.[REF6] The objective of this study was to evaluate post hoc the relationship between BMI and abatacept response in ASTRAEA.

Methods: Patients were randomized (1:1) to weekly SC abatacept 125 mg or placebo for 24W. Patients without ≥20% improvement in joint counts at W16 were switched to open-label abatacept (early escape). Patients designated as early escape or with missing data were imputed as non-responders. ACR20/50/70 responses and percentages of patients with DAS28 (CRP) ≤3.2 or <2.6, MDA, HAQ-DI response (change from baseline [CFB] ≥0.35) and radiographic non-progression (PsA-modified total Sharp/van der Heijde score, CFB ≤0) at W24 were compared for abatacept vs placebo between three BMI subgroups (underweight/normal: <25 kg/m²; overweight: 25–30 kg/m²; obese: >30 kg/m²) using univariate and multivariate analyses. BMI <25 kg/m² subgroup was the reference and key potential confounding factors for treatment efficacy were included in the multivariate model. Odds ratios (ORs), 95% CIs and p values were calculated for each BMI subgroup comparison.

Results: Overall, 212 abatacept- and 210 placebo-treated patients had available baseline BMI status. For abatacept vs placebo, 31 (14.6%) vs 39 (18.6%) were underweight/normal, 77 (36.3%) vs 57 (27.1%) were overweight and 104 (49.1%) vs 114 (54.3%) were obese. In the abatacept and placebo groups, neither overweight nor obese patients had a significantly lower ACR20 response compared with underweight/normal patients in the univariate model. These results were confirmed in the multivariate models in overweight and obese patients, vs underweight/normal patients: abatacept group: OR (95% CI) 1.215 (0.437, 3.378), p=0.7087 and 0.446 (0.162, 1.228), p=0.1181; placebo group: OR (95% CI) 0.554 (0.189, 1.621), p=0.2811 and 0.460 (0.166, 1.271), p=0.1343. Similar results were observed for all other outcomes tested (Figure 1 [Fig. 1]).

Conclusion: As in RA, BMI does not appear to affect the efficacy of abatacept in PsA across both objective and patient-reported outcome measures. Given that 1 in 3 patients with PsA are overweight/obese, these data strongly suggest an advantage of abatacept therapy in this debilitating disease.


References

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Kumar S, et al. J Eur Acad Dermatol Venereol. 2013;27:1293–8.
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Eder L, et al. Ann Rheum Dis. 2015;74:813–7.
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di Minno MN, et al. Arthritis Care Res (Hoboken). 2013;65:141–7.
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Gremese E, et al. Front Immunol. 2014;5:576.
6.
Mease P, et al. Arthritis Rheumatol. 2016;68(Suppl 10):[Abstract 1041].