The results of the ARIAA study suggest that treating pre-clinical RA is likely to pay off.
The ARIAA study looks at early drug intervention in at-risk individuals with pre-clinical RA.
They enrolled an enriched population, those with ACPA positivity and MRI signs of inflammation. Patients had more than 6 weeks of arthralgia without any clinical synovitis and were not allowed any glucocorticoids or DMARDs.
If a patient in this category had made their way to my clinic, I would be tempted to treat, or at very least, I would monitor them closely.
ARIAA is a randomised double-blinded placebo-controlled multi-center study. Patients were provided 6 months of treatment, either abatacept subcutaneously at the standard 125mg weekly or placebo.
After this defined 6 months, patients were followed up for 12 months without any treatment. MRI was performed every 6 months.
The 6-month data was presented at ACR 2021.
There were 49 pretty well-matched patients in each group, a participant total of 98.
After 6 months, the primary endpoint of ARIAA was reached with 61% of those receiving abatacept showing improvement in at least one of the MRI parameters (synovitis, tenosynovitis, and osteitis) compared to 31% in the placebo group (p=0.0043).
In addition, rheumatoid arthritis developed in 17 patients in the placebo group (34.7%) versus only 4 patients (8.2%) in the abatacept group (p= 0.0025).
This was promising data. What would happen during the next 12 months?
Well, a sustained effect for the 6-month course of abatacept was presented at ACR 2022.
Analysis of the MRI findings at 18 months, showed that 28 patients (57.1%) in the abatacept group were MRI responders showing improvement in synovitis, tenosynovitis or osteitis. In the placebo group, 14 patients (28.6%) were MRI responders (p=0.0076).
More importantly, 12 months after cessation of abatacept, progression to RA was still clearly lower in the abatacept group (35%) than in the placebo group (57%; p=0.0076).
Nice. Sure, there are still questions to be answered but does this data change what you do?
I am inclined to treat this high-risk, pre-clinical RA group. The extrapolation, problematic as it may be, is that treating with any effective DMARD is likely to be helpful.
At some stage, as pricing improves, we should get to use specialised DMARDs upfront, such as abatacept, and perhaps, as the studies accumulate, in a defined short-course manner.
- 0530 Abatacept Significantly Reduces Subclinical Inflammation During Treatment (6 Months), This Persists After Discontinuation (12 Months), Resulting in a Delay in the Clinical Development of RA in Patients at Risk of RA (The ARIAA Study)
