Decreased use of glucocorticoids in biological-experienced patients with rheumatoid arthritis who initiated intravenous abatacept: results from the 2-year ACTION study

Abstract

IntroductionProlonged glucocorticoid use may increase the risk of adverse safety outcomes, including cardiovascular events. The European League Against Rheumatism and the Canadian Rheumatology Association advise tapering glucocorticoid dose as rapidly as clinically feasible. There is a paucity of published data on RA that adequately describe concomitant treatment patterns.MethodsACTION (AbataCepT In rOutiNe clinical practice) is a non-interventional cohort study of patients from Europe and Canada that investigated the long-term retention of intravenous abatacept in clinical practice. We assessed concomitant glucocorticoids in patients with established RA who had participated in ACTION and received ≥1 biological agent prior to abatacept initiation.ResultsThe analysis included 1009 patients. Glucocorticoids were prescribed at abatacept initiation in 734 (72.7%) patients at a median 7.5 mg/day dose (n=692). Of the patients who remained on abatacept at 24 months, 40.7% were able to decrease their dose of glucocorticoids, including 26.9% who decreased their dose from >5 mg/day to ≤5 mg/day.ConclusionReduction and/or cessation of glucocorticoid therapy is possible with intravenous abatacept in clinical practice.

Dynamical trajectory of glucocorticoids tapering and discontinuation in patients with rheumatoid arthritis commencing glucocorticoids with csDMARDs: a real-world data from 2009 to 2020

“…2 7 Previous clinical investigations have evaluated the feasibility of GC discontinuation by introducing the bDMARD or tofacitinib. [27][28][29][30][31][32] For example, Inoue et al analysed 80 patients with RA taking a median PSL dose of 5.0 (1.0-10.0) mg/day at bDMARDs initiation. 31 Over a median follow-up of 33.1 months, 31.3% of participants discontinued GC.…”

Effect of Glucocorticoids on the Clinical and Radiographic Efficacy of Tofacitinib in Patients with Rheumatoid Arthritis: A Posthoc Analysis of Data from 6 Phase III Studies

“…GC use prior to the enrollment of patients was not specified in the inclusion and exclusion criteria of these studies. Tocilizumab and abatacept have shown GC-sparing effects, in that the dose of GC may be reduced while the patient is receiving bDMARD without inhibiting clinical improvement in disease activity 37,38 . Similarly, because the efficacy of tofacitinib may not be affected by concomitant GC therapy, it is possible that patients using both treatments may be able to reduce the dose of GC.…”

Phase 1 clinical trial evaluating abatacept in patients with steroid-refractory chronic graft-versus-host disease

“…[28][29][30] Moreover, the use of abatacept in rheumatoid arthritis has been shown to result in decreased prednisone use. 31 As such, immunomodulation via costimulatory blockade with abatacept represents a highly novel and promising approach for the treatment of cGVHD.…”