REVIEW - Costimulation blockade in rheumatic diseases: where are we?

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Curr Opin Rheumatol. 2009 Apr 1.

Costimulation blockade in rheumatic diseases: where we are?

Goëb V, Buch MH, Vital EM, Emery P.

Section of Musculoskeletal Disease, Leeds Institute of Molecular

Medicine, University of Leeds, Leeds, UK.

PURPOSE OF REVIEW: To describe the mechanisms of action of abatacept

(CTLA4-Ig) and summarize the evidence of its efficacy and safety in

rheumatoid arthritis (RA) and other rheumatic diseases such as

juvenile idiopathic arthritis (JIA).

RECENT FINDINGS: Several studies have demonstrated the clinical

efficacy (disease activity, quality of life, prevention of structural

damage) of abatacept in patients with RA who have failed to respond to

standard disease-modifying antirheumatic drugs (DMARDs) and antitumour

necrosis factor-alpha biologic agents. Selective modulation of T-cell

costimulation may also be an alternative therapy for children with JIA

who are resitant to conventional DMARDs or biologics.

SUMMARY: T-cell activation is critical to the onset and maintenance of

RA. Abatacept (CTLA4-Ig), the first selective T-cell costimulation

modulator has shown to be effective in RA and JIA. Recent 2-year data

from the 'AIM' trial suggests an increased and sustained effect of

blocking of T cell signalling on the inhibition of RA structural

damage progression over time. Abatacept's safety profile in

combination with DMARDs also seems to be favourable but should be

avoided in combination with other biologics.

PMID: 19342956

http://www.ncbi.nlm.nih.gov/pubmed/19342956

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