SubQ Abatacept for RA Comparable to IV Formulation

Michael Schiff. Subcutaneous abatacept for the treatment of rheumatoid arthritis. 
Rheumatology (2013) 52:986-997

A review of five clinical trials shows that a new subcutaneous (subQ) formulation of abatacept (Orencia) is as safe and effectivefor rheumatoid arthritis (RA) as intravenous abatacept, in the short term, and that it appears to maintain improvements in clinical and functional efficacy over time.

The trials, involving 2,446 patients altogether (the majority women, with a median age of 51.5), indicate that subQ abatacept improves the signs, symptoms, disease activity, and physical function of patients with RA – with low immunogenicity and sustained benefits.

A head-to-head study comparing subQ abatacept plus methotrexate (MTX) to adalimumab (Humira) and MTX in biologic-naive RA patients found safety and inhibition of structural damage progression to be similar over one year. This study also proposes considering the two treatments equally for patients with RA who have not responded adequately to MTX.

Additionally, the overall review suggests that clinicians can safely switch patients from IV to subQ abatacept (a fixed weekly dose versus a monthly tiered IV dose based on body weight). Clinical effects can be expected to be similar, and the effect on immunogenicity to be small.