Abatacept and Glucocorticoids as One Could be a Combo Worth Exploring

A short report published in the current issue of RMD Open suggests that reducing or stopping glucocorticoid therapy can be achieved safely with intravenous abatacept.

Although the long-term use of glucocorticoids has been associated with dangerous side effects, such as an increased risk for bone fractures and cardiovascular events in rheumatology patients, low-dose treatments can be beneficial for some patients. Few studies, until now, have explored concomitant glucocorticoid treatment patterns.

“Low-dose glucocorticoids (≤5 mg/day prednisone or equivalent) remain an important treatment option given their capacity to increase clinical, functional and structural efficacy when combined  with csDMARDs.  However, EULAR and the Canadian Rheumatology Association advise tapering the glucocorticoid dose as rapidly as clinically feasible to minimize safety concerns associated with prolonged use,” wrote the authors who were led by Rieke Alten of Germany.[[{"type":"media","view_mode":"media_crop","fid":"45908","attributes":{"alt":"@Burlingham/Shutterstock.com","class":"media-image media-image-right","id":"media_crop_8233199315145","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"5284","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"font-size: 13.008px; line-height: 1.538em; float: right;","title":"@Burlingham.Shutterstock.com","typeof":"foaf:Image"}}]]

The findings are based on the results of the two-year ACTION (Abatacept in Routine Clinical Practice) non-interventional cohort study of 1,009 European and Canadian patients with rheumatoid arthritis. Glucocorticoids were prescribed at the start of receiving abatacept in 734 (72.7%) patients  who received a median of 7.5 mg/day dose (n=692).  

For patients who remained on abatacept for two years, 40.7% were able to decrease their dose of glucocorticoids, including 26.9% who decreased their dose from >5 mg/day to ≤5 mg/day.

This was an observational study inherent with some limitations, such as the lack of a comparative group. Yet, it is the first prospective study to analyze the concomitant use of glucocorticoids and abatacept. Other studies, the authors noted, have shown that some successful treatment strategies, that include biological agents, can lead to the reduction of the use of glucocorticoids over time.

“The clinical importance of these findings is reflected in current EULAR recommendations wherein glucocorticoids can be considered part of the initial 6-month combination treatment with the recommendation to taper as rapidly as clinically feasible,” the authors wrote.

References:

Rieke Alten, Hubert Nublein, et. al. "Decreased use of glucocorticoids in biological-experienced patients with rheumatoid arthritis who initiated intravenous abatacept: results from the 2-year ACTION study,"

RMD Open. Published online Feb. 16, 2016. (http://dx.doi.org/ 10.1136/rmdopen-2015-000228).