CorEvitas, LLC, 350 5th Avenue, Waltham, MA, 02451, USA.
University of Massachusetts Medical School, Worcester, MA, USA.
Adv Rheumatol. 2024 Jan 19;64(1):10. doi: 10.1186/s42358-024-00352-4.
The HLA-DRB1 shared epitope (SE) is a risk factor for the development of rheumatoid arthritis (RA) and the production of anti-citrullinated protein antibodies (ACPAs) in RA patients. Our objective was to examine the real-world effectiveness of abatacept versus tumor necrosis factor inhibitors (TNFi) in patients with RA who were SE and anti-cyclic citrullinated peptide antibody (anti-CCP3) positive.
Abatacept or TNFi initiators who were SE + and anti-CCP3+ (> 20 U/mL) at or prior to treatment and had moderate or high CDAI score (> 10) at initiation were identified. The primary outcome was mean change in CDAI score over six months. Analyses were conducted in propensity score (PS)-trimmed and -matched populations overall and a biologic-experienced subgroup. Mixed-effects models were used.
In the overall PS-trimmed (abatacept, n = 170; TNFi, n = 157) and PS-matched cohorts (abatacept, n = 111; TNFi, n = 111), there were numerically greater improvements in mean change in CDAI between abatacept and TNFi but were not statistically significant. Similar trends were seen for biologic-experienced patients, except that statistical significance was reached for mean change in CDAI in the PS-trimmed cohort (abatacept, 12.22 [95% confidence interval (95%CI) 10.13 to 14.31]; TNFi, 9.28 [95%CI 7.08 to 11.48]; p = 0.045).
In this real world cohort, there were numerical improvements in efficacy outcomes with abatacept over TNFi in patients with RA who were SE + and ACPA+, similar to results from a clinical trial population The only statistically significant finding after adjusting for covariates was greater improvement in CDAI with abatacept versus TNFi in the bio-experienced PS-trimmed cohort..
人类白细胞抗原-DRB1 共享表位（SE）是类风湿关节炎（RA）发展和 RA 患者产生抗瓜氨酸蛋白抗体（ACPAs）的风险因素。我们的目的是研究在 SE 和抗环瓜氨酸肽抗体（抗-CCP3）阳性的 RA 患者中，阿巴西普与肿瘤坏死因子抑制剂（TNFi）的真实世界疗效。
在治疗时或治疗前 SE 阳性和抗-CCP3 阳性（>20 U/mL），且起始时 CDAI 评分中度或高度（>10）的阿巴西普或 TNFi 起始者被确定。主要结局是 6 个月时 CDAI 评分的平均变化。在倾向评分（PS）修剪和匹配的总体人群以及生物经验亚组中进行了分析。使用混合效应模型。
在总体 PS 修剪（阿巴西普，n=170；TNFi，n=157）和 PS 匹配队列（阿巴西普，n=111；TNFi，n=111）中，阿巴西普与 TNFi 相比，CDAI 评分的平均变化有更大的改善，但无统计学意义。在生物经验患者中也出现了类似的趋势，但在 PS 修剪队列的 CDAI 评分平均变化方面达到了统计学意义（阿巴西普，12.22[95%置信区间（95%CI）10.13 至 14.31]；TNFi，9.28[95%CI 7.08 至 11.48]；p=0.045）。
在这个真实世界的队列中，在 SE 阳性和 ACPA 阳性的 RA 患者中，阿巴西普在疗效方面有数值上的改善，优于临床试验人群的结果。在调整协变量后，唯一具有统计学意义的发现是在生物经验 PS 修剪队列中，与 TNFi 相比，阿巴西普在 CDAI 方面的改善更大。
