REVIEW - Orencia for RA: a Cochrane systematic review

[Guest guest]

J Rheumatol. 2010 Jan 15.

Abatacept for Rheumatoid Arthritis: A Cochrane Systematic Review.

Maxwell LJ, Singh JA.

From the Institute of Population Health, University of Ottawa, Ottawa,

Ontario, Canada; and Rheumatology Section, Veterans Affairs Medical

Center , Division of Rheumatology, Department of Medicine, University

of Minnesota, Minneapolis, and Department of Health Sciences and

Orthopaedic Surgery, Mayo Clinic School of Medicine, Rochester ,

Minnesota, USA.

OBJECTIVE: To perform a systematic review of efficacy and safety of

abatacept in patients with rheumatoid arthritis (RA).

METHODS: We searched the Cochrane Library, MEDLINE, EMBASE, ACP

Journal Club, and Biosis Previews for randomized controlled trials

(RCT) comparing abatacept alone or in combination with disease

modifying antirheumatic drugs (DMARD)/biologics to placebo or other

DMARD/biologics in patients with RA. Two reviewers independently

assessed search results, risk of bias, and extracted data.

RESULTS: Seven trials with 2908 patients were included. Compared with

placebo, patients with RA treated with abatacept were 2.2 times more

likely to achieve an American College of Rheumatology 50% response

(ACR50) at one year (relative risk 2.21, 95% CI 1.73, 2.82) with a 21%

(95% CI 16%, 27%) absolute risk difference between groups. The number

needed to treat to achieve an ACR50 response was 5 (95% CI 4, 7).

Significantly greater improvements in physical function, disease

activity, pain, and radiographic progression were noted in

abatacept-treated patients compared to placebo. Total adverse events

(AE) were greater in the abatacept group (RR 1.05, 95% CI 1.01, 1.08).

Other harm outcomes were not significant, with the exception of

serious infections at 12 months, which were more common in the

abatacept group versus control group (Peto odds ratio 1.91, 95% CI

1.07, 3.42). Serious AE were more numerous in the abatacept +

etanercept group versus the placebo + etanercept group (RR 2.30, 95%

CI 1.15, 4.62).

CONCLUSION: Abatacept seems to be efficacious and safe in the

treatment of RA. Abatacept should not be used in combination with

other biologics to treat RA. Further longterm studies and

postmarketing surveillance are required to assess for longer-term

harms and sustained efficacy.

PMID: 20080922

http://www.ncbi.nlm.nih.gov/pubmed/20080922

Not an MD