Abstract
Abatacept (CTLA4-Ig) is a fully humanized soluble selective T-cell costimulatory inhibitor. Randomized controlled trials (RCTs) of abatacept have demonstrated its efficacy in patients with rheumatoid arthritis (RA) who either are methotrexatenaive 1 or have had an inadequate response to methotrexate 2,3 or antiYtumor necrosis factor (anti-TNF) therapy. 4 Data on the effectiveness and safety of abatacept in patients who have failed multiple biologics with different mechanisms of action, however, are limited. In the RCT of abatacept in TNF-failure patient cohorts, the majority of patients had failed only 1 anti-TNF agent, and no patients had previously received rituximab (RTX). 4 Observational data on the effectiveness in daily clinical practice are also scarce 5 but important, because they provide realworld effectiveness and safety data in patients who often differ from patients included in RCTs. 6 In this study, we describe our experience with abatacept in treating patients with severe RA after failure of anti-TNF therapy and after failure of both anti-TNF therapy and RTX. Our hypothesis was that abatacept was an effective and safe agent in patients with RA refractory to multiple therapeutic agents.
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