Summary

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• Orencia (abatacept) is indicated for the treatment of adult patients with moderately to severely active rheumatoid arthritis (RA); for the treatment of patients 2 years of age and older with moderately to severely active polyarticular juvenile idiopathic arthritis (pJIA); for the treatment of adult patients with active psoriatic arthritis (PsA); and for the prophylaxis of acute graft versus host disease (aGVHD), in combination with a calcineurin inhibitor and methotrexate, in adults and pediatric patients 2 years of age and older undergoing hematopoietic stem cell transplantation (HSCT) from a matched or 1 allele-mismatched unrelated donor.
• This summary is based on the review of 26 systematic review(s)/meta-analysis(es). ^[1-26]
• Glucocorticoid Withdrawal: After one year, the odds ratios for discontinuing glucocorticoid use were 2.19 for TNF-inhibitors, 2.46 for tocilizumab, and 1.73 for abatacept. Compared to TNF-inhibitors, adjusted hazard ratios were 1.1 for abatacept and 1.30 for tocilizumab.
• Remission Rates After Tapering: Remission rates varied from 14-28% when targeted monotherapy was stopped, with higher remission rates up to 72% observed in dose reduction studies. Early RA trials showed remission rates of 27-72%, while established RA trials showed 14-20%.
• RA-Associated Interstitial Lung Disease (ILD): No significant changes in FVC, FEV1, and DLCO were observed with ncs-DMARD treatment, except in the rituximab subgroup, which showed significant FVC improvement.
• Efficacy in Rheumatoid Arthritis: Abatacept demonstrated higher ACR 20/50/70/90 response rates compared to placebo, conventional synthetic DMARDs, and other biologic DMARDs.
• Adverse Events: Abatacept-treated patients had fewer adverse events compared to other b/tsDMARDs; no significant differences in adverse events between bDMARDs, including abatacept, were noted.
• Serious Adverse Events: Abatacept demonstrated lower relative rates of serious adverse events in JIA compared to other biologics, and fewer serious adverse events in trials compared to TNFi and JAK inhibitors.
• Infections: Abatacept was associated with lower infection rates compared to other biologics.
• Population Types and Subgroup Considerations: Specific population types and subgroups include patients with RA (including those with RA-associated ILD, endothelial dysfunction, or subclinical atherosclerosis), JIA (both systemic and non-systemic), PsA, and lupus nephritis. Relevant findings highlight higher remission rates in early RA compared to established RA after treatment tapering, significant FVC improvement in RA-associated ILD with rituximab, greater net benefit of abatacept in systemic JIA, and a lower risk of cardiovascular events with abatacept in RA patients compared to TNFi.