Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Assessment of Cardiovascular Markers after 24 Weeks of Abatacept or Rituximab Therapy in Patients with Rheumatoid Arthritis.

Mathieu3,  Sylvain, Szymanski1,  Gauthier, Dubost2,  Jean-Jacques, Mrozek4,  Natacha, Marceau1,  Geoffroy, Ristori4,  Jean-Michel, Soubrier4,  Martin

Biochimie, CHU Gabriel Montpied, Clermont-Ferrand, France
Humatologie, CHU Gabriel Montpied, Clermont-Ferrand, France
Rhumatologie, CHU Gabriel Montpied, Clermont-Ferrand, France
Rhumatologie, CHU Gabriel Montpied, Clermont-Ferrand, France

Background:

Increased incidence of cardiovascular disease has been observed in rheumatoid arthritis (RA). Several studies have attributed this excess cardiac risk to biological inflammation. Effective control of inflammation may be of benefit in reducing cardiovascular risk in RA patients.

Objectives:

To investigate the effects of abatacept and rituximab treatment in active RA on markers of atherosclerosis: arterial stiffness measured by augmentation index (AIx) and pulse wave velocity (PWV), lipoproteins, pro-brain natriuretic peptide (pro-BNP) and soluble levels of Receptor for Advanced Glycation Endproducts (sRAGE).

Methods:

PWV, AIx, clinical status, lipoproteins, systemic inflammation, pro-BNP and s-RAGE were assessed at baseline and after 24 weeks of abatacept and rituximab therapy.

Results:

Thirty RA patients, including 27 women, with a mean age of 58.0 ± 11.6 years and a longstanding disease of about 11 years received rituximab therapy. Of these 30 patients, 90% had rheumatoid factor, 80% anti-CCP antibody and 93.3% were erosive. Nineteen patients had failed to respond to TNF alpha inhibitor treatments.

Seventeen RA patients (14 female), with a mean age of 60.6 ± 14.1 years were treated by abatacept. Of these 17 patients, 47.1% had positive rheumatoid factors, 76.5% had positive anti-CCP antibody, and all were erosive. Twelve patients were non-responders to TNF alpha inhibitor treatments and 7 (41.1%) to rituximab treatment.

1) Arterial stiffness. After abatacept treatment, no change was observed in PWV (8.6 ± 4.2 vs. 9.4 ± 3.1 m/s; p=0.09) and AIx (29.9 ± 10.6 vs. 30.1 ± 9.3%; p=0.98). With rituximab, an improvement in AIx was obtained (AIx: 29.1 ± 8.0% vs. 31.7 ± 10.5%; p=0.024) but not to a level of significance for PWV (7.9 ± 2.7 vs. 8.1 ± 3.4 m/s; p=0.620).

2) Lipoproteins and other cardiovascular risk markers. After both treatments, a significant increase in the level of apolipoprotein A1 (apoA1) and a tendency to a decrease in the apolipoprotein B/apoA1 ratio were obtained. No change was found in levels of pro-BNP, sRAGE or apoB.

3) Disease activity. DAS28 ESR and DAS28 CRP were significantly improved after both rituximab and abatacept. We found a decrease in parameters of biological inflammation, significant after rituximab and not significant after abatacept.

Conclusion:

This study shows that arterial stiffness, occurring in RA, was not improved after 6 months of abatacept or rituximab therapy, nor pro-BNP and s-RAGE. However, the treatment did have a beneficial effect on lipid profile and so it would be interesting to have an assessment over a longer period, especially since abatacept and rituximab are not anticytokine therapies.

To cite this abstract, please use the following information:
Mathieu, Sylvain, Szymanski, Gauthier, Dubost, Jean-Jacques, Mrozek, Natacha, Marceau, Geoffroy, Ristori, Jean-Michel, et al; Assessment of Cardiovascular Markers after 24 Weeks of Abatacept or Rituximab Therapy in Patients with Rheumatoid Arthritis. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :375
DOI: 10.1002/art.28144

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