Abatacept inhibits progression of structural damage in rheumatoid arthritis: results from the long-term extension of the AIM trial.
OBJECTIVE
Assess the effect of abatacept on progression of structural damage over 2 years in patients with rheumatoid arthritis who had an inadequate response to methotrexate.


METHODS
539 patients entered an open-label extension of the AIM (Abatacept in Inadequate responders to Methotrexate) trial and received abatacept. Radiographic assessment of the hands and feet was performed at baseline, year 1 and year 2. At year 2, each patient's radiographs were scored for progression blinded to sequence and treatment allocation.


RESULTS
In patients treated with abatacept for 2 years, greater reduction in progression of structural damage was observed in year 2 than in year 1. The mean change in total Genant-modified Sharp scores was reduced from 1.07 units in year 1 to 0.46 units in year 2. Similar reductions were observed in erosion and joint space narrowing scores. Following 2 years of treatment with abatacept, 50% of patients had no progression of structural damage as defined by a change in the total score of < or =0 compared with baseline. 56% of patients treated with abatacept had no progression during the first year compared with 45% of patients treated with placebo. In their second year of treatment with abatacept, more patients had no progression than in the first year (66% vs 56%).


CONCLUSIONS
Abatacept has a sustained effect that inhibits progression of structural damage. Furthermore, the mean change in radiographic progression in patients treated with abatacept for 2 years was significantly lower in year 2 versus year 1, suggesting that abatacept may have an increasing disease-modifying effect on structural damage over time.
Genant
H K
HK
University of California, San Francisco, San Francisco, CA, USA. harry.genant@ucsf.edu
Peterfy
C G
CG
Westhovens
R
R
Becker
J-C
JC
Aranda
R
R
Vratsanos
G
G
Teng
J
J
Kremer
J M
JM
D000069594:Abatacept; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging / Q000188:drug therapy*; D018450:Disease Progression; D005384:Finger Joint / Q000000981:diagnostic imaging; D005500:Follow-Up Studies; D033023:Foot Joints / Q000000981:diagnostic imaging; D006801:Humans; D018796:Immunoconjugates / Q000627:therapeutic use*; D011859:Radiography; D016032:Randomized Controlled Trials as Topic
D018501:Antirheumatic Agents; D018796:Immunoconjugates; D000069594:Abatacept