UpdatesPlus - EULAR - AVERT data reported - Orencia (abatacept)/MTX demonstrates efficacy in early rheumatoid arthritis

The alert below is from our EULAR 2014 coverage.  We have captured most of the key oral and poster presentations delivered at EULAR and will be analyzing these more comprehensively in upcoming issues of our UpdatesPlus service.  UpdatesPlus is a service comprising alerts and monthly reports including pipeline and trial updates plus analysis of key information.  The service is designed for industry and academics across the immunology & Inflammation spectrum.  To register for UpdatesPlus or to get further information please contact fiona.watts@leaddiscovery.co.uk

• AVERT was presented last week by Emery
  
• This 351 patients study enrolled patients with early RA (2yrs, anti-ccp, das28 at least 3.2)
  
• Patients were naive to biologics and MTX
• Patients were randomized to receive MTX, Orencia (abatacept; 125mg qw) or a combination of the two treatments
• Baseline characteristics were presented and of note disease activity was particularly high at baseline
• As mentioned in our alert from yesterday, DAS28 CRP remission at 12mo was improved from 45% with MTX alone to 61% with an MTX/Orencia combo
• As shown below, remission was lost over 6 months following the withdrawal of all RA drug therapies (co-primary endpoint) although more patients previously receiving Orencia/MTX remained in remission than those receiving MTX alone (15% vs 8% with MTX alone)
• From the figure below we suggest that the duration over which 50% patients lost remission was approximately 10wks [note that this is our analysis]
• Emery reported that maintained remission was associated with lower baseline DAS28 (CRP); lower HAQ-DI; shorter symptom duration and faster remission

Comments:  We have previously suggested that it would be important to better understand the time to loss of response and biomarkers/baseline characteristics that predict this loss of response.  Both questions were addressed in today's presentation.  We suggest that while some patients with high baseline disease activity may require prolonged biologic treatment, other could be controlled by initial treatment per label but then maintained with reduced treatment frequency.  This would have obvious benefits of reduced cost and improved convenience/safety