Wash-out unnecessary before starting abatacept
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Patients with rheumatoid arthritis who fail on anti-TNF
therapy may benefit from a second or third biologic |
Rheumatoid arthritis patients who do not respond to tumour necrosis
factor (TNF) inhibitors do not need a wash-out period before starting abatacept
(Orencia), according to data presented last week at the annual congress
of the European League Against Rheumatism (EULAR) in Barcelona.
The new study assessed abatacept safety in 842 patients who started taking
it after inadequate response to an anti-TNF. Of these, 370 were classed
as “prior” users as they had stopped the therapy at least two
months before entering the study. The remaining 472 “current” users
had received an anti-TNF within two months of starting abatacept.
After six months, the frequency of adverse events, serious adverse events,
infections, neoplasms and deaths was similar in both groups.
Abatacept was launched in the UK last week but has been available in
the US for about a year. Most other biologic therapies used to treat rheumatoid
arthritis are TNF inhibitors but abatacept works by selectively inhibiting
T-cell activation.
Michael Schiff, of the University of Colorado School of Medicine in Denver,
said: “It’s become a common question: how long do we have to
wait before starting abatacept? But these data are encouraging and suggest
we don’t have to wait for a wash-out period.”
Anthony Hammond, consultant rheumatologist at Maidstone and Tunbridge
Wells NHS Trust, was a UK investigator for the abatacept trial. He said: “We’ve
seen good results with this drug. And remember that these are patients with
serious rheumatic disease who have failed on both methotrexate and anti-TNFs,
so it’s a welcome addition.”
The results were presented days after the National Institute for Health
and Clinical Excellence agreed to review its decision not to recommend trying
a second anti-TNF therapy following poor response to a first.
Dr Hammond welcomed the decision and added: “Latest data from the
British Society for Rheumatology Biologics Register show that many patients
derive benefit from a second and even a third biologic.
“If you take money out of the equation cycling biologics is certainly
worthwhile.”
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