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Emery P, Tanaka Y, Bykerk VP, Huizinga TWJ, Citera G, Bingham CO, Banerjee S, Soule BP, Nys M, Connolly SE, Lozenski KL, Zhuo J, Wong R, Huang KHG, Fleischmann R. Sustained Remission and Outcomes with Abatacept plus Methotrexate Following Stepwise Dose De-escalation in Patients with Early Rheumatoid Arthritis. Rheumatol Ther 2023; 10:707-727. [PMID: 36869251 PMCID: PMC10140217 DOI: 10.1007/s40744-022-00519-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 12/02/2022] [Indexed: 03/05/2023] Open
Abstract
INTRODUCTION One target of rheumatoid arthritis (RA) treatment is to achieve early sustained remission; over the long term, patients in sustained remission have less structural joint damage and physical disability. We evaluated Simplified Disease Activity Index (SDAI) remission with abatacept + methotrexate versus abatacept placebo + methotrexate and impact of de-escalation (DE) in anti-citrullinated protein antibody (ACPA)-positive patients with early RA. METHODS The phase IIIb, randomized, AVERT-2 two-stage study (NCT02504268) evaluated weekly abatacept + methotrexate versus abatacept placebo + methotrexate. PRIMARY ENDPOINT SDAI remission (≤ 3.3) at week 24. Pre-planned exploratory endpoint: maintenance of remission in patients with sustained remission (weeks 40 and 52) who, from week 56 for 48 weeks (DE period), (1) continued combination abatacept + methotrexate, (2) tapered abatacept to every other week (EOW) + methotrexate for 24 weeks with subsequent abatacept withdrawal (abatacept placebo + methotrexate), or (3) withdrew methotrexate (abatacept monotherapy). RESULTS Primary study endpoint was not met: 21.3% (48/225) of patients in the combination and 16.0% (24/150) in the abatacept placebo + methotrexate arm achieved SDAI remission at week 24 (p = 0.2359). There were numerical differences favoring combination therapy in clinical assessments, patient-reported outcomes (PROs) and week 52 radiographic non-progression. After week 56, 147 patients in sustained remission with abatacept + methotrexate were randomized (combination, n = 50; DE/withdrawal, n = 50; abatacept monotherapy, n = 47) and entered DE. At DE week 48, SDAI remission (74%) and PRO improvements were mostly maintained with continued combination therapy; lower remission rates were observed with abatacept placebo + methotrexate (48.0%) and with abatacept monotherapy (57.4%). Before withdrawal, de-escalating to abatacept EOW + methotrexate preserved remission. CONCLUSIONS The stringent primary endpoint was not met. However, in patients achieving sustained SDAI remission, numerically more maintained remission with continued abatacept + methotrexate versus abatacept monotherapy or withdrawal. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT02504268. Video abstract (MP4 62241 KB).
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Affiliation(s)
- Paul Emery
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and Leeds NIHR Biomedical Research Centre, Leeds, UK.
| | - Yoshiya Tanaka
- First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Vivian P Bykerk
- Department of Rheumatology, Hospital for Special Surgery, New York City, NY, USA
| | - Thomas W J Huizinga
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Gustavo Citera
- Department of Rheumatology, Instituto de Rehabilitación Psicofísca, Buenos Aires, Argentina
| | - Clifton O Bingham
- Divisions of Rheumatology and Allergy, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Subhashis Banerjee
- Immunology and Fibrosis/Global Drug Development, Bristol Myers Squibb, Princeton, NJ, USA
| | - Benjamin P Soule
- Fibrosis Business Development, Bristol Myers Squibb, Princeton, NJ, USA
| | - Marleen Nys
- Global Biometrics and Data Science, Bristol Myers Squibb, Braine-l'Alleud, Belgium
| | - Sean E Connolly
- Immunology and Fibrosis/Global Drug Development, Bristol Myers Squibb, Princeton, NJ, USA
| | - Karissa L Lozenski
- Immunology and Fibrosis/Global Drug Development, Bristol Myers Squibb, Princeton, NJ, USA
| | - Joe Zhuo
- Worldwide Health Economics and Outcomes Research, Bristol Myers Squibb, Princeton, NJ, USA
| | - Robert Wong
- Immunology and Fibrosis/Global Drug Development, Bristol Myers Squibb, Princeton, NJ, USA
| | - Kuan-Hsiang Gary Huang
- Immunology and Fibrosis/Global Drug Development, Bristol Myers Squibb, Princeton, NJ, USA
| | - Roy Fleischmann
- Division of Rheumatology, University of Texas Southwestern Medical Center and Metroplex Clinical Research Center, Dallas, TX, USA
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Fraietta JA, Mueller YM, Lozenski KL, Ratner D, Boesteanu AC, Hancock AS, Lackman-Smith C, Zentner IJ, Chaiken IM, Chung S, LeGrice SFJ, Snyder BA, Mankowski MK, Jones NM, Hope JL, Gupta P, Anderson SH, Wigdahl B, Katsikis PD. Abasic phosphorothioate oligomers inhibit HIV-1 reverse transcription and block virus transmission across polarized ectocervical organ cultures. Antimicrob Agents Chemother 2014; 58:7056-71. [PMID: 25224013 PMCID: PMC4249537 DOI: 10.1128/aac.02991-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 09/02/2014] [Indexed: 11/20/2022] Open
Abstract
In the absence of universally available antiretroviral (ARV) drugs or a vaccine against HIV-1, microbicides may offer the most immediate hope for controlling the AIDS pandemic. The most advanced and clinically effective microbicides are based on ARV agents that interfere with the earliest stages of HIV-1 replication. Our objective was to identify and characterize novel ARV-like inhibitors, as well as demonstrate their efficacy at blocking HIV-1 transmission. Abasic phosphorothioate 2' deoxyribose backbone (PDB) oligomers were evaluated in a variety of mechanistic assays and for their ability to inhibit HIV-1 infection and virus transmission through primary human cervical mucosa. Cellular and biochemical assays were used to elucidate the antiviral mechanisms of action of PDB oligomers against both lab-adapted and primary CCR5- and CXCR4-utilizing HIV-1 strains, including a multidrug-resistant isolate. A polarized cervical organ culture was used to test the ability of PDB compounds to block HIV-1 transmission to primary immune cell populations across ectocervical tissue. The antiviral activity and mechanisms of action of PDB-based compounds were dependent on oligomer size, with smaller molecules preventing reverse transcription and larger oligomers blocking viral entry. Importantly, irrespective of molecular size, PDBs potently inhibited virus infection and transmission within genital tissue samples. Furthermore, the PDB inhibitors exhibited excellent toxicity and stability profiles and were found to be safe for vaginal application in vivo. These results, coupled with the previously reported intrinsic anti-inflammatory properties of PDBs, support further investigations in the development of PDB-based topical microbicides for preventing the global spread of HIV-1.
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Affiliation(s)
- Joseph A Fraietta
- Department of Microbiology and Immunology and Center for Immunology and Vaccine Science, Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Yvonne M Mueller
- Department of Microbiology and Immunology and Center for Immunology and Vaccine Science, Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Karissa L Lozenski
- Department of Microbiology and Immunology and Center for Immunology and Vaccine Science, Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Deena Ratner
- Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Alina C Boesteanu
- Department of Microbiology and Immunology and Center for Immunology and Vaccine Science, Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Aidan S Hancock
- Department of Microbiology and Immunology and Center for Immunology and Vaccine Science, Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | | | - Isaac J Zentner
- Department of Biochemistry and Molecular Biology, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Irwin M Chaiken
- Department of Biochemistry and Molecular Biology, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Suhman Chung
- HIV Drug Resistance Program, National Cancer Institute, National Institutes of Health, Frederick, Maryland, USA
| | - Stuart F J LeGrice
- HIV Drug Resistance Program, National Cancer Institute, National Institutes of Health, Frederick, Maryland, USA
| | - Beth A Snyder
- Southern Research Institute, Frederick, Maryland, USA
| | | | | | - Jennifer L Hope
- Department of Microbiology and Immunology and Center for Immunology and Vaccine Science, Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Phalguni Gupta
- Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sharon H Anderson
- Department of Obstetrics & Gynecology, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA Main Line Fertility Center, Bryn Mawr, Pennsylvania, USA
| | - Brian Wigdahl
- Department of Microbiology and Immunology and Center for Immunology and Vaccine Science, Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Peter D Katsikis
- Department of Microbiology and Immunology and Center for Immunology and Vaccine Science, Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
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