RA remission rates higher with abatacept, certolizumab pegol vs conventional therapy

In the treatment of rheumatoid arthritis (RA), more patients achieve clinical remission with abatacept or certolizumab pegol, but not with tocilizumab, than with active conventional therapy, according to a study.

The study included 812 patients with treatment-naïve early RA with moderate–severe disease activity. They were randomly assigned to receive treatment with methotrexate plus one of the following: (1) active conventional therapy: oral prednisolone (tapered quickly, discontinued at week 36) or sulfasalazine, hydroxychloroquine, and intra-articular glucocorticoid injections in swollen joints; (2) certolizumab pegol; (3) abatacept; or (4) tocilizumab.

Coprimary endpoints were Clinical Disease Activity Index (CDAI) remission (CDAI ≤2.8) and change in radiographic van der Heijde-modified Sharp Score at week 48. Logistic regression and analysis of covariance were used to estimate differences between the treatment groups.

Adjusted CDAI remission rates at week 48 were 59.3 percent with abatacept, 52.3 percent with certolizumab, 51.9 percent with tocilizumab, and 39.2 percent with active conventional therapy. The difference in CDAI remission rates relative to active conventional therapy was significantly higher for abatacept (adjusted difference 20.1 percent; p<0.001) and certolizumab (adjusted difference 13.1 percent; p=0.021), but not for tocilizumab (adjusted difference 12.7 percent; p=0.030).  

Results for key secondary clinical outcomes were consistently better in biological groups. Meanwhile, radiographic progression was low and comparable across all treatment groups.

The frequency of serious adverse events was 8.3 percent with abatacept, 12.4 percent with certolizumab, 9.2 percent with tocilizumab, and 10.7 percent with active conventional therapy.