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Abatacept Monotherapy Versus Abatacept Plus Methotrexate for Treatment-Refractory Rheumatoid Arthritis

Pascart, Tristan, MD1,2,3,*; Philippe, Peggy, MD2; Drumez, Elodie, PhD4; Deprez, Xavier, MD5; Cortet, Bernard, MD, PhD2,3; Duhamel, Alain, MD, PhD4; Houvenagel, Eric, MD1; Flipo, René-Marc, MD, PhD2

American Journal of Therapeutics: May/June 2019 - Volume 26 - Issue 3 - p e358–e363
doi: 10.1097/MJT.0000000000000645
Brief Reports

Background: Methotrexate combination therapy improves abatacept efficacy as a first-line biologic agent for the treatment of rheumatoid arthritis, but it is unclear when abatacept is used later on, particularly after non–TNF inhibitor (TNFi) failure.

Study Question: The objective of this study was to determine whether treatment response after non–TNFi inadequate response is different in patients with rheumatoid arthritis (RA) treated with abatacept in combination with or not with methotrexate.

Methods: Patients treated with abatacept monotherapy or in combination with methotrexate after non–TNFi failure were included.

Results: Data from 46 patients aged 56 years [49–61] with 12 years [8–16] of disease duration were examined. Rituximab was the treatment used in the previous line for 75.0% of the combination therapy group (15/20) and 34.6% (9/26) in the monotherapy group. At 12 months, 38.5% (10/26) of patients were in good-to-moderate EULAR response in the monotherapy group compared with 25.0% (5/20) in the combination therapy group (P = 0.33). Treatment persistence at 12 months was 61.5% (16/26) in the monotherapy group and 35.0% (7/20) in the combination therapy group (P = 0.07).

Conclusions: Adding methotrexate to abatacept did not improve treatment response in patients with RA after non–TNFi inadequate response.

1Department of Rheumatology, Saint-Philibert Hospital, Lille University, Lomme, France;

2Department of Rheumatology, University-Hospital of Lille, Lille Cedex, France;

3EA 4490, University-Hospital of Lille, Lille Cedex, France;

4Department of Biostatistics, EA2694, University of Lille, CHRU Lille, Lille, France; and

5Department of Rheumatology, Valenciennes Hospital, Valenciennes, France.

Address for correspondence: Saint-Philibert Hospital, rue du Grand But, 59160 Lomme, France. E-mail:

R.-M. Flipo received research grants from Roche. B. Cortet received fees from MSD, Roche, Amgen, Ferring, Lilly, Medtronics, Novartis, Rottapharm, and Servier below $10,000. E. Houvenagel received fees from Abbvie, Pfizer, Roche, MSD, and BMS below $10,000. The remaining authors have no conflicts of interest to declare.

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