Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement

The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.


An Increasing Proportion of Patients Achieve a Low Disease Activity State or Remission When Switched From Infliximab to Abatacept Regardless of Initial Infliximab Treatment Response: Results From the ATTEST Trial

Schiff1,  M., Keiserman2,  M. W., Moniz Reed3,  D., Bars4,  M. Le, Becker3,  J.-C., Zhao3,  C., Dougados5,  M.

Univ of Colorado School of Medicine, Denver, CO,
Pontificial Catholic Univ, Porto Alegre, Brazil,
Bristol-Myers Squibb, Princeton, NJ,
Bristol-Myers Squibb, Rueil-Malmaison, France,
Hospital Cochin, Descartes Univ, Paris, France

Purpose:

Clinical trials of patients (pts) who switch between biologic therapies generally assess pts after failure of a prior biologic. At Yr 1 of ATTEST1 (Abatacept or infliximab vs placebo, a Trial for Tolerability, Efficacy and Safety in Treating RA) all pts received abatacept regardless of clinical response or original treatment group. Uniquely, this trial design allowed the assessment of pts who switched from infliximab to abatacept after 1 yr, with various degrees of prior response to infliximab.

Methods:

Biologic-naïve pts with RA were randomized to abatacept (~10 mg/kg every 4 weeks), placebo or infliximab (3 mg/kg every 8 weeks), plus MTX. At Mth 6 and Yr 1, placebo- and infliximab-treated pts, respectively, were switched to abatacept. Disease activity was assessed by DAS28 (CRP). High, Moderate and Low Disease Activity States (HDAS, MDAS and LDAS, respectively), and remission were defined as >5.1, >3.2–5.1, ²2.6–3.2 and <2.6, respectively. These as-observed post-hoc analyses include pts originally randomized to infliximab who entered the long-term extension and had data available at Yr 1 and Yr 2. Data from the original abatacept group are not presented here.

Results:

In total, 136 infliximab-treated pts entered the LTE and were eligible for inclusion in these analyses. After switching from infliximab to abatacept at Yr 1, 81.5% (22/27) of pts who were in HDAS improved their disease state by Yr 2. The majority of pts in MDAS and LDAS after 1 yr of infliximab treatment improved their disease state after receiving abatacept for 1 yr (at Yr 2, 60.7 [34/56] and 64.3%[9/14] had improved, respectively). Of the pts who had achieved remission after 1 yr of infliximab treatment, 71.4% maintained their disease state at Yr 2 after switching to abatacept.

Disease status at Yr 1Shift in DAS28 status from Yr 1 to Yr 2 after switching from infliximab to abatacept, %
 Total, % (n)HDASMDAS*LDASRemission
HDAS21.6 (27)18.555.67.418.5
MDAS*44.8 (56)5.433.933.926.8
LDAS11.2 (14)021.414.364.3
Remission22.4 (28)3.614.310.771.4
*But not LDAS/remission;But not remission

Conclusion:

In these post-hoc analyses, despite 1 yr of infliximab treatment, the majority of patients improved/maintained their disease status after switching to abatacept regardless of their initial infliximab treatment response. In total, an additional 30% of patients achieved remission after switching to abatacept.

Reference:

1.Schiff, M, et al. Ann Rheum Dis 2007;8:1096–103.

To cite this abstract, please use the following information:
Schiff, M., Keiserman, M. W., Moniz Reed, D., Bars, M. Le, Becker, J.-C., Zhao, C., et al; An Increasing Proportion of Patients Achieve a Low Disease Activity State or Remission When Switched From Infliximab to Abatacept Regardless of Initial Infliximab Treatment Response: Results From the ATTEST Trial [abstract]. Arthritis Rheum 2009;60 Suppl 10 :1659
DOI: 10.1002/art.26733

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