THU0106 In Patients with Rheumatoid Arthritis and an Inadequate Response to Methotrexate, does Body Mass Index Influence the Efficacy of Abatacept on Inflammation when Measured by Power Doppler Ultrasonography? Results from the Appraise Study

Abstract

BackgroundStudies have shown an influence of BMI on clinical outcomes in patients with RA treated by anti-TNF agents.1 The efficacy of abatacept does not seem to be impacted by weight; baseline weight was not identified as a predictive factor of efficacy (DAS28 [CRP] <2.6) in a post hoc analysis of the AVERT trial2 and, in real-world analyses, BMI did not impact the retention rate on drug or effectiveness.3,4 Clinical evaluation of RA in obese patients can be difficult, but power Doppler ultrasound (PDUS) is a method for evaluating joints that can differentiate joint effusion from synovitis and identify real disease activity due to RA. APPRAISE was the first prospective, multinational study to use the composite greyscale/PDUS synovitis score, developed by the OMERACT-EULAR Ultrasound Task Force, to measure early signs of response to treatment with IV abatacept plus MTX.5-7ObjectivesTo explore the effect of BMI on the efficacy of IV abatacept plus MTX using PDUS.MethodsPDUS was assessed over 6 months in underweight/normal (<25 kg/m2), overweight (25–<30 kg/m2) and obese (≥30 kg/m2) patients receiving IV abatacept plus MTX. Efficacy was assessed by the percentage of patients achieving DAS28 (CRP) <2.6, low disease activity (DAS28 [CRP] ≤3.2) or clinically meaningful improvement (change in DAS28 [CRP] of ≥1.2).ResultsOf the 96/104 patients evaluable for PDUS, 46 (47.9%) had a BMI <25 kg/m2, 28 (29.2%) were overweight and 22 (22.9%) were obese. Baseline demographics and disease characteristics were comparable between the BMI subgroups; however, differences were noted at baseline between global PDUS joint effusion scores within each BMI subgroup: mean (SD) score was 15.7 (15.2) for the underweight/normal group, 19.6 (16.1) for the overweight group and 23.0 (16.4) for the obese group. Mean changes from baseline in PDUS and DAS28 (CRP) scores over 6 months for each BMI subgroup are presented; no differences between the BMI subgroups were detected (Figure). Note that when using more stringent criteria such as the percentage of patients reaching DAS28 (CRP) <2.6 over time, a greater response within the first month was seen in the underweight/normal group versus overweight and obese groups, influenced mainly by high-sensitivity CRP and patient global assessment; responses were otherwise similar over 6 months.ConclusionsThis post hoc analysis of the APPRAISE study confirms that BMI does not affect clinical response to IV abatacept plus MTX nor does it influence the magnitude in changes of PDUS-detected inflammation over time.ReferencesGremese E, et al. Arthritis Care Res 2013;65:94–100.Emery P, et al. Arthritis Rheum 2014;66(Suppl 11):S1084. Poster 2485.Nüsslein H, et al. Arthritis Rheum 2014;66(Suppl 11):S1088. Poster 2492.Iannone F, et al. Ann Rheum Dis 2014;73(Suppl 2):498–9. Poster FRI0313.D'Agostino MA et al. Ann Rheum Dis 2012;71(Suppl 3):186. Poster THU0095.D'Agostino MA, et al. Arthritis Rheum 2012;64(Suppl 10):S352. Poster 810.D'Agostino MA, et al. Arthritis Rheum 2012;64(Suppl 10):S353. Poster 811.Disclosure of Int...

Body mass index and treatment response to subcutaneous abatacept in patients with psoriatic arthritis: apost hocanalysis of a phase III trial

“…In summary, the results reported here indicate that BMI does not appear to impact the response to abatacept administered at the approved dose of 125 mg SC weekly in patients with PsA across multiple outcome measures, similar to reported findings in RA 5 6 10. Given that obesity is common in patients with PsA and negatively impacts treatment response to TNFis,1 2 8 9 these data suggest that abatacept can be considered as an important treatment option for patients with PsA irrespective of BMI status.…”

“…The difference in the impact of BMI on response to abatacept versus TNF is seen in PsA has also been observed in RA. Previous findings from interventional trials and real-world studies showed that, as reported here for PsA, BMI does not affect retention or the response to abatacept in patients with RA 5 6 10–12. In contrast, obesity was significantly associated with reduced treatment response to TNFis in a meta-analysis of patients with rheumatic diseases, including RA and PsA, based on multiple outcome measures including European League Against Rheumatism response and a 75% reduction in the PASI score (PASI 75) 2.…”

“…Indeed, abatacept, available as an intravenous or subcutaneous (SC) formulation, is approved for the treatment of moderate-to-severe rheumatoid arthritis (RA), juvenile idiopathic arthritis and PsA 4. Evidence from interventional trials and real-world studies has shown that BMI does not affect treatment response to abatacept in patients with RA 5 6. However, there are limited data on the impact of BMI on response to abatacept in patients with PsA.…”

Body mass index and clinical response to intravenous or subcutaneous abatacept in patients with rheumatoid arthritis

“…In the real-world ACTION study and a pan-European analysis of pooled RA registry data, good/moderate European League Against Rheumatism (EULAR) responses were achieved across all BMI subgroups [ 16 , 30 ]. Similarly, a post hoc analysis of data from the APPRAISE study showed that baseline BMI did not influence the effect of abatacept on synovitis detected by the objective measure of power Doppler ultrasonography [ 17 ]. These findings contrast with the evidence for TNFis, which indicates reduced efficacy in patients with higher BMI [ 9 , 31 ].…”