title: Is there still a role for abatacept in the treatment of lupus?
abstract: BACKGROUND
  The quest for safer and more effective treatments for systemic lupus erythematosus (SLE) has led to the development of many new biologic therapies. Abatacept is the first drug targeting co-stimulation between T cells and antigen presenting cells, with abundant pre-clinical evidence to support its use in SLE.
  
  
  METHODS
  This review will present the relevant aspects of lupus pathophysiology pertaining to the mechanism of action of abatacept, a summary of murine studies and the latest human clinical trials.
  
  
  CONCLUSIONS
  Abatacept has demonstrated efficacy in both rheumatoid arthritis and psoriatic arthritis, and earlier studies have suggested tantalising evidence of efficacy in SLE. However, the latest randomised double-blinded study showed disappointingly negative results, much like the case of rituximab in SLE. Currently, abatacept remains a possible therapeutic option as an off-label therapy, and it is a part of our therapeutic armamentarium in difficult cases. The need to find appropriate definitions of response and optimal study design continues to be paramount in the field of lupus therapies.
authors.affiliation: Department of Rheumatology, Monash Health , 246 Clayton Road, Clayton, Victoria 3168 , Australia alberta.hoi@monash.edu.
authors.forename: Alberta
authors.initials: A
authors.lastname: Hoi
authors.forename: Geoff
authors.initials: G
authors.lastname: Littlejohn
mesh_terms: D000069594:Abatacept; D000818:Animals; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D001691:Biological Therapy / Q000379:methods; D006801:Humans; D018796:Immunoconjugates / Q000627:therapeutic use*; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy* / Q000276:immunology; D000069283:Rituximab; D013601:T-Lymphocytes / Q000502:physiology; D016896:Treatment Outcome
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D018501:Antirheumatic Agents; D018796:Immunoconjugates; D000069283:Rituximab; D000069594:Abatacept
keywords: abatacept; biologics; lupus; lupus nephritis; targeted therapy