title: Differences in Predictive Factors for Sustained Clinical Remission with Abatacept Between Younger and Elderly Patients with Biologic-naive Rheumatoid Arthritis: Results from the ABROAD Study.
abstract: To differentiate predictive factors for sustained clinical remission between elderly and younger patients with rheumatoid arthritis (RA) receiving abatacept (ABA) as an initial biological disease-modifying antirheumatic drug.
  
  
  
  The study involved 277 biologic-naive patients with RA with high or moderate disease activity, who were treated with intravenous ABA and evaluated for 48 weeks in 43 Japanese hospitals and rheumatology clinics (the ABatacept Research Outcomes as a First-line Biological Agent in the Real WorlD study: UMIN000004651). Predictive factors associated with sustained clinical remission defined by the 28-joint Disease Activity Score with C-reactive protein (DAS28-CRP) during the 24-48-week or 36-48-week periods were determined in elderly (≥ 65 yrs, n = 148) and younger patient groups (< 65 yrs, n = 129) using logistic regression analysis.
  
  
  
  Clinical remission was achieved at 24 and 48 weeks in 35.1% and 36.5% of patients in the elderly group and 34.9% and 43.4% in the younger group, respectively. In elderly patients, anticitrullinated protein antibody (ACPA) positivity and a lower DAS28-CRP score were significantly associated with sustained clinical remission; however, a lower Health Assessment Questionnaire-Disability Index (HAQ-DI) score was not related to sustained clinical remission. In younger patients, lower DAS28-CRP and HAQ-DI scores were predictive factors for sustained clinical remission, whereas ACPA positivity was not a useful predictive factor for sustained clinical remission.
  
  
  
  Although the effectiveness of ABA in biologic-naive patients with RA was equally recognized in elderly and younger patients, the baseline clinical characteristics associated with sustained clinical remission were substantially different.
authors: From the Division of Rheumatology, Department of Internal Medicine, Hyogo College of Medicine, Hyogo; Department of Rheumatology and Clinical Immunology, and the Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine, Kyoto University; Department of Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto; Osaka Rheumatology Clinic and Institute of Medical Science, Osaka; Tokyo Medical University, Tokyo, Japan. masa-s@hyo-med.ac.jp.|M. Sekiguchi, MD, PhD, Hyogo College of Medicine; T. Fujii, MD, PhD, Graduate School of Medicine, Kyoto University; K. Matsui, MD, PhD, Hyogo College of Medicine; K. Murakami, MD, PhD, Graduate School of Medicine, Kyoto University; S. Morita, MD, PhD, Graduate School of Medicine, Kyoto University; K. Ohmura, MD, PhD, Graduate School of Medicine, Kyoto University; Y. Kawahito, MD, PhD, Graduate School of Medical Science, Kyoto Prefectural University of Medicine; N. Nishimoto, MD, PhD, Osaka Rheumatology Clinic and Institute of Medical Science, Tokyo Medical University; T. Mimori, MD, PhD, Graduate School of Medicine, Kyoto University; H. Sano, MD, PhD, Hyogo College of Medicine. Dr. Sekiguchi and Dr. Fujii contributed equally to this study. masa-s@hyo-med.ac.jp.
authors: Masahiro
authors: M
authors: Sekiguchi
authors: From the Division of Rheumatology, Department of Internal Medicine, Hyogo College of Medicine, Hyogo; Department of Rheumatology and Clinical Immunology, and the Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine, Kyoto University; Department of Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto; Osaka Rheumatology Clinic and Institute of Medical Science, Osaka; Tokyo Medical University, Tokyo, Japan.|M. Sekiguchi, MD, PhD, Hyogo College of Medicine; T. Fujii, MD, PhD, Graduate School of Medicine, Kyoto University; K. Matsui, MD, PhD, Hyogo College of Medicine; K. Murakami, MD, PhD, Graduate School of Medicine, Kyoto University; S. Morita, MD, PhD, Graduate School of Medicine, Kyoto University; K. Ohmura, MD, PhD, Graduate School of Medicine, Kyoto University; Y. Kawahito, MD, PhD, Graduate School of Medical Science, Kyoto Prefectural University of Medicine; N. Nishimoto, MD, PhD, Osaka Rheumatology Clinic and Institute of Medical Science, Tokyo Medical University; T. Mimori, MD, PhD, Graduate School of Medicine, Kyoto University; H. Sano, MD, PhD, Hyogo College of Medicine. Dr. Sekiguchi and Dr. Fujii contributed equally to this study.
authors: Takao
authors: T
authors: Fujii
authors: From the Division of Rheumatology, Department of Internal Medicine, Hyogo College of Medicine, Hyogo; Department of Rheumatology and Clinical Immunology, and the Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine, Kyoto University; Department of Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto; Osaka Rheumatology Clinic and Institute of Medical Science, Osaka; Tokyo Medical University, Tokyo, Japan.|M. Sekiguchi, MD, PhD, Hyogo College of Medicine; T. Fujii, MD, PhD, Graduate School of Medicine, Kyoto University; K. Matsui, MD, PhD, Hyogo College of Medicine; K. Murakami, MD, PhD, Graduate School of Medicine, Kyoto University; S. Morita, MD, PhD, Graduate School of Medicine, Kyoto University; K. Ohmura, MD, PhD, Graduate School of Medicine, Kyoto University; Y. Kawahito, MD, PhD, Graduate School of Medical Science, Kyoto Prefectural University of Medicine; N. Nishimoto, MD, PhD, Osaka Rheumatology Clinic and Institute of Medical Science, Tokyo Medical University; T. Mimori, MD, PhD, Graduate School of Medicine, Kyoto University; H. Sano, MD, PhD, Hyogo College of Medicine. Dr. Sekiguchi and Dr. Fujii contributed equally to this study.
authors: Kiyoshi
authors: K
authors: Matsui
authors: From the Division of Rheumatology, Department of Internal Medicine, Hyogo College of Medicine, Hyogo; Department of Rheumatology and Clinical Immunology, and the Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine, Kyoto University; Department of Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto; Osaka Rheumatology Clinic and Institute of Medical Science, Osaka; Tokyo Medical University, Tokyo, Japan.|M. Sekiguchi, MD, PhD, Hyogo College of Medicine; T. Fujii, MD, PhD, Graduate School of Medicine, Kyoto University; K. Matsui, MD, PhD, Hyogo College of Medicine; K. Murakami, MD, PhD, Graduate School of Medicine, Kyoto University; S. Morita, MD, PhD, Graduate School of Medicine, Kyoto University; K. Ohmura, MD, PhD, Graduate School of Medicine, Kyoto University; Y. Kawahito, MD, PhD, Graduate School of Medical Science, Kyoto Prefectural University of Medicine; N. Nishimoto, MD, PhD, Osaka Rheumatology Clinic and Institute of Medical Science, Tokyo Medical University; T. Mimori, MD, PhD, Graduate School of Medicine, Kyoto University; H. Sano, MD, PhD, Hyogo College of Medicine. Dr. Sekiguchi and Dr. Fujii contributed equally to this study.
authors: Kosaku
authors: K
authors: Murakami
authors: From the Division of Rheumatology, Department of Internal Medicine, Hyogo College of Medicine, Hyogo; Department of Rheumatology and Clinical Immunology, and the Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine, Kyoto University; Department of Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto; Osaka Rheumatology Clinic and Institute of Medical Science, Osaka; Tokyo Medical University, Tokyo, Japan.|M. Sekiguchi, MD, PhD, Hyogo College of Medicine; T. Fujii, MD, PhD, Graduate School of Medicine, Kyoto University; K. Matsui, MD, PhD, Hyogo College of Medicine; K. Murakami, MD, PhD, Graduate School of Medicine, Kyoto University; S. Morita, MD, PhD, Graduate School of Medicine, Kyoto University; K. Ohmura, MD, PhD, Graduate School of Medicine, Kyoto University; Y. Kawahito, MD, PhD, Graduate School of Medical Science, Kyoto Prefectural University of Medicine; N. Nishimoto, MD, PhD, Osaka Rheumatology Clinic and Institute of Medical Science, Tokyo Medical University; T. Mimori, MD, PhD, Graduate School of Medicine, Kyoto University; H. Sano, MD, PhD, Hyogo College of Medicine. Dr. Sekiguchi and Dr. Fujii contributed equally to this study.
authors: Satoshi
authors: S
authors: Morita
authors: From the Division of Rheumatology, Department of Internal Medicine, Hyogo College of Medicine, Hyogo; Department of Rheumatology and Clinical Immunology, and the Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine, Kyoto University; Department of Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto; Osaka Rheumatology Clinic and Institute of Medical Science, Osaka; Tokyo Medical University, Tokyo, Japan.|M. Sekiguchi, MD, PhD, Hyogo College of Medicine; T. Fujii, MD, PhD, Graduate School of Medicine, Kyoto University; K. Matsui, MD, PhD, Hyogo College of Medicine; K. Murakami, MD, PhD, Graduate School of Medicine, Kyoto University; S. Morita, MD, PhD, Graduate School of Medicine, Kyoto University; K. Ohmura, MD, PhD, Graduate School of Medicine, Kyoto University; Y. Kawahito, MD, PhD, Graduate School of Medical Science, Kyoto Prefectural University of Medicine; N. Nishimoto, MD, PhD, Osaka Rheumatology Clinic and Institute of Medical Science, Tokyo Medical University; T. Mimori, MD, PhD, Graduate School of Medicine, Kyoto University; H. Sano, MD, PhD, Hyogo College of Medicine. Dr. Sekiguchi and Dr. Fujii contributed equally to this study.
authors: Koichiro
authors: K
authors: Ohmura
authors: From the Division of Rheumatology, Department of Internal Medicine, Hyogo College of Medicine, Hyogo; Department of Rheumatology and Clinical Immunology, and the Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine, Kyoto University; Department of Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto; Osaka Rheumatology Clinic and Institute of Medical Science, Osaka; Tokyo Medical University, Tokyo, Japan.|M. Sekiguchi, MD, PhD, Hyogo College of Medicine; T. Fujii, MD, PhD, Graduate School of Medicine, Kyoto University; K. Matsui, MD, PhD, Hyogo College of Medicine; K. Murakami, MD, PhD, Graduate School of Medicine, Kyoto University; S. Morita, MD, PhD, Graduate School of Medicine, Kyoto University; K. Ohmura, MD, PhD, Graduate School of Medicine, Kyoto University; Y. Kawahito, MD, PhD, Graduate School of Medical Science, Kyoto Prefectural University of Medicine; N. Nishimoto, MD, PhD, Osaka Rheumatology Clinic and Institute of Medical Science, Tokyo Medical University; T. Mimori, MD, PhD, Graduate School of Medicine, Kyoto University; H. Sano, MD, PhD, Hyogo College of Medicine. Dr. Sekiguchi and Dr. Fujii contributed equally to this study.
authors: Yutaka
authors: Y
authors: Kawahito
authors: From the Division of Rheumatology, Department of Internal Medicine, Hyogo College of Medicine, Hyogo; Department of Rheumatology and Clinical Immunology, and the Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine, Kyoto University; Department of Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto; Osaka Rheumatology Clinic and Institute of Medical Science, Osaka; Tokyo Medical University, Tokyo, Japan.|M. Sekiguchi, MD, PhD, Hyogo College of Medicine; T. Fujii, MD, PhD, Graduate School of Medicine, Kyoto University; K. Matsui, MD, PhD, Hyogo College of Medicine; K. Murakami, MD, PhD, Graduate School of Medicine, Kyoto University; S. Morita, MD, PhD, Graduate School of Medicine, Kyoto University; K. Ohmura, MD, PhD, Graduate School of Medicine, Kyoto University; Y. Kawahito, MD, PhD, Graduate School of Medical Science, Kyoto Prefectural University of Medicine; N. Nishimoto, MD, PhD, Osaka Rheumatology Clinic and Institute of Medical Science, Tokyo Medical University; T. Mimori, MD, PhD, Graduate School of Medicine, Kyoto University; H. Sano, MD, PhD, Hyogo College of Medicine. Dr. Sekiguchi and Dr. Fujii contributed equally to this study.
authors: Norihiro
authors: N
authors: Nishimoto
authors: From the Division of Rheumatology, Department of Internal Medicine, Hyogo College of Medicine, Hyogo; Department of Rheumatology and Clinical Immunology, and the Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine, Kyoto University; Department of Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto; Osaka Rheumatology Clinic and Institute of Medical Science, Osaka; Tokyo Medical University, Tokyo, Japan.|M. Sekiguchi, MD, PhD, Hyogo College of Medicine; T. Fujii, MD, PhD, Graduate School of Medicine, Kyoto University; K. Matsui, MD, PhD, Hyogo College of Medicine; K. Murakami, MD, PhD, Graduate School of Medicine, Kyoto University; S. Morita, MD, PhD, Graduate School of Medicine, Kyoto University; K. Ohmura, MD, PhD, Graduate School of Medicine, Kyoto University; Y. Kawahito, MD, PhD, Graduate School of Medical Science, Kyoto Prefectural University of Medicine; N. Nishimoto, MD, PhD, Osaka Rheumatology Clinic and Institute of Medical Science, Tokyo Medical University; T. Mimori, MD, PhD, Graduate School of Medicine, Kyoto University; H. Sano, MD, PhD, Hyogo College of Medicine. Dr. Sekiguchi and Dr. Fujii contributed equally to this study.
authors: Tsuneyo
authors: T
authors: Mimori
authors: From the Division of Rheumatology, Department of Internal Medicine, Hyogo College of Medicine, Hyogo; Department of Rheumatology and Clinical Immunology, and the Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine, Kyoto University; Department of Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto; Osaka Rheumatology Clinic and Institute of Medical Science, Osaka; Tokyo Medical University, Tokyo, Japan.|M. Sekiguchi, MD, PhD, Hyogo College of Medicine; T. Fujii, MD, PhD, Graduate School of Medicine, Kyoto University; K. Matsui, MD, PhD, Hyogo College of Medicine; K. Murakami, MD, PhD, Graduate School of Medicine, Kyoto University; S. Morita, MD, PhD, Graduate School of Medicine, Kyoto University; K. Ohmura, MD, PhD, Graduate School of Medicine, Kyoto University; Y. Kawahito, MD, PhD, Graduate School of Medical Science, Kyoto Prefectural University of Medicine; N. Nishimoto, MD, PhD, Osaka Rheumatology Clinic and Institute of Medical Science, Tokyo Medical University; T. Mimori, MD, PhD, Graduate School of Medicine, Kyoto University; H. Sano, MD, PhD, Hyogo College of Medicine. Dr. Sekiguchi and Dr. Fujii contributed equally to this study.
authors: Hajime
authors: H
authors: Sano
mesh_terms: D000069594:Abatacept / Q000627:therapeutic use*; D000328:Adult; D000367:Age Factors; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012074:Remission Induction / Q000379:methods*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D000069594:Abatacept
keywords: ABATACEPT; ANTICITRULLINATED PROTEIN ANTIBODIES; CLINICAL REMISSION; HEALTH ASSESSMENT QUESTIONNAIRE-DISABILITY INDEX; METHOTREXATE; RHEUMATOID ARTHRITIS