We aimed to reveal the effect of abatacept (ABT) on atherosclerosis in rheumatoid arthritis (RA) patients, 3-year efficacy for arthritis, and safety in a population of older vs. younger patients. In this open-label, prospective, observational study, patients were stratified into four groups: younger (20–64 years old) and older (≥ 65 years) patients taking ABT (AY and AO) and conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) (CY and CO). Primary endpoints were change from baseline in mean intima-media thickness (IMT) of the common carotid artery, IMT max (bulbus, bifurcation, and internal and common carotid artery), and plaque score at Week 156. Disease activity, retention rate, and adverse effects were also evaluated. The ABT group (AY + AO) tended to have smaller increases in mean IMT, max IMT, and plaque score than the csDMARD group (CY + CO) at Week 156, although the differences between groups were not statistically significant. Multivariate analysis showed significantly lower increases in plaque score with ABT than with csDMARDs, only when considering disease activity at 156 weeks (p = 0.0303). Proportions of patients with good or good/moderate European League Against Rheumatism response were higher in the ABT group, without significant difference between older and younger patients. No significant differences were observed in ABT retention rates between older and younger patients. Serious adverse effects, especially infection, tended to be more frequent with ABT than with csDMARDs, although no significant differences were found. ABT may decelerate atherosclerosis progression and may be useful for patients with high risk of cardiovascular disease, such as older patients. UMIN000014913.

中文翻译：

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阿巴西普对老年类风湿关节炎患者与年轻类风湿关节炎患者动脉粥样硬化和关节炎的长期影响：一项前瞻性、多中心、观察性研究的 3 年结果

我们的目的是揭示阿巴西普 (ABT) 对类风湿性关节炎 (RA) 患者动脉粥样硬化的影响、关节炎的 3 年疗效以及老年患者与年轻患者的安全性。在这项开放标签、前瞻性、观察性研究中，患者被分为四组：年轻（20-64 岁）和老年（≥ 65 岁）患者服用 ABT（AY 和 AO）和传统合成缓解病情抗风湿药物（ csDMARD）（CY 和 CO）。主要终点是颈总动脉平均内膜中层厚度 (IMT) 相对于基线的变化、IMT 最大值（球部、分叉部、颈内动脉和颈总动脉）以及第 156 周时的斑块评分。疾病活动性、保留率和还评估了不良反应。第 156 周时，ABT 组 (AY + AO) 的平均 IMT、最大 IMT 和斑块评分的增加往往比 csDMARD 组 (CY + CO) 更小，但组间差异不具有统计学意义。多变量分析显示，仅当考虑 156 周时的疾病活动时，ABT 的斑块评分增幅显着低于 csDMARD（p = 0.0303）。 ABT 组中欧洲抗风湿联盟反应良好或良好/中等的患者比例较高，但老年患者和年轻患者之间没有显着差异。老年患者和年轻患者之间的 ABT 保留率没有观察到显着差异。尽管未发现显着差异，但 ABT 组的严重不良反应（尤其是感染）往往比 csDMARD 组更常见。 ABT 可以减缓动脉粥样硬化的进展，对于心血管疾病高风险患者（例如老年患者）可能有用。 UMIN000014913。