Add-on tacrolimus a viable option for RA patients with insufficient abatacept response

Use of tacrolimus (TAC) appears to be safe and effective in the management of rheumatoid arthritis (RA) patients with inadequate response to abatacept, as shown in a recent study.

The analysis included 25 abatacept-treated RA patients (mean age, 67.0 years; disease duration, 16.2 years) who received add-on TAC therapy and were followed for >24 weeks. The mean duration of abatacept treatment at TAC initiation was 1.2 years, with a mean dose of 1.2 mg/d at baseline and 1.6 mg/d at week 24. Many patients had a pulmonary comorbidity (10 patients; 40.0 percent), including six with interstitial pneumonia and four with old pulmonary tuberculosis.

Majority of the patients (84.0 percent) did not use concomitant methotrexate (MTX), the reasons for which included the following: interstitial pneumonia, pulmonary tuberculosis, bacterial pneumonia, sore throat, renal dysfunction, septic shock, physician judgment and patient preference.

There were 20 patients (80 percent) who were treated with abatacept without any concomitant conventional synthetic disease modifying antirheumatic drugs. More than half of the patients were treated with oral glucocorticoids. Mean disease activity as assessed by DAS28‐ESR score was 4.97, corresponding to moderate disease activity.

Mean Disease Activity Score of 28 joints-erythrocyte sedimentation rate decreased substantially, from 4.97 at baseline to 3.35 at week 24. The rate of low disease activity or remission was 40.0 percent, while that of moderate or good response according to the European League Against Rheumatism criteria was 72.0 percent.

Kaplan-Meier analysis showed that the abatacept retention rate was high at 92.0 percent at week 24. Only one patient discontinued TAC therapy due to an adverse event (itching sensation).

The present data indicate that TAC therapy is a viable complementary treatment option in daily clinical practice, researchers said.