Abatacept in individuals with autoantibody-positive arthralgia at risk for rheumatoid arthritis

Disease prevention has become the holy grail of medicine. Rheumatoid arthritis (RA) is one of the most common chronic autoimmune diseases and advances in its therapeutic options, including progress in prevention strategies, can affect other autoimmune diseases. It is suitable to study secondary prevention of RA since individuals at risk can be identified by a combination of symptoms (ie, arthralgia suspected of RA progression), whereas the hallmark for its diagnosis (clinical arthritis) remains absent. 1 van Steenbergen HW Aletaha D Beaart-van de Voorde LJ et al. EULAR definition of arthralgia suspicious for progression to rheumatoid arthritis. Ann Rheum Dis. 2017; 76: 491-496 Crossref PubMed Scopus (187) Google Scholar Autoantibodies against citrullinated protein antigens (ACPAs) or imaging findings like subclinical joint inflammation in patients at risk further increase the risk of RA. Abatacept inhibits inflammation and onset of rheumatoid arthritis in individuals at high risk (ARIAA): a randomised, international, multicentre, double-blind, placebo-controlled trial6-month treatment with abatacept decreases MRI inflammation, clinical symptoms, and risk of rheumatoid arthritis development in participants at high risk. The effects of the intervention persist through a 1-year drug-free observation phase. Full-Text PDF Abatacept in individuals at high risk of rheumatoid arthritis (APIPPRA): a randomised, double-blind, multicentre, parallel, placebo-controlled, phase 2b clinical trialTherapeutic intervention during the at-risk phase of rheumatoid arthritis is feasible, with acceptable safety profiles. T-cell co-stimulation modulation with abatacept for 12 months reduces progression to rheumatoid arthritis, with evidence of sustained efficacy beyond the treatment period, and with no new safety signals. Full-Text PDF Open Access