Abatacept Beats HCQ in Halting RA in Palindromic Rheumatism
Abatacept outperformed hydroxychloroquine (HCQ) in preventing patients with palindromic rheumatism (PR) from progressing to rheumatoid arthritis (RA).
METHODOLOGY:
Researchers randomly assigned 70 individuals with PR who were seropositive for rheumatoid factor or anti-citrullinated protein antibodies in a 1:1 ratio to receive open-label abatacept (ABA) at 125 mg/week or HCQ at 5 mg/kg/day for 1 year.
All patients had symptom durations of over 3 months but under 3 years and were not taking any disease-modifying antirheumatic drugs or glucocorticoids.
Patients were followed for an additional year to track RA development.
TAKEAWAY:
At month 24, three patients (8.8%) in the ABA group progressed to RA compared with 10 patients (27.8%) in the HCQ group (P = .047).
Patients treated with HCQ who developed RA generally progressed in the first 12 months of the trial, whereas patients treated with ABA who developed RA did so at the end of the second year.
The ABA group also had higher persistent remission rates of PR than the HCQ group (55.9% vs 22.9%).
Serious adverse events were uncommon in both treatment groups.
IN PRACTICE:
'In patients with recent-onset seropositive palindromic rheumatism, abatacept significantly decreased the rate of RA progression in comparison with hydroxychloroquine at 2 years follow-up,' said study author Raimon Sanmarti, MD, PhD, of the Hospital Clínic de Barcelona, Barcelona, Spain. 'Abatacept is also more efficacious than hydroxychloroquine in the control of symptoms of seropositive palindromic rheumatism.'
SOURCE:
Sanmarti presented the study in an oral abstract session at the European Alliance of Associations for Rheumatology (EULAR) 2025 Annual Meeting.
LIMITATIONS:
This was an open-label study with a relatively small sample of patients. Over the 2-year trial, eight patients in the HCQ group and five patients in the ABA group exited the trial or were lost to follow-up.
DISCLOSURES:
The Fundació Clínic per a la Recerca Biomèdica sponsored the study. Sanmarti disclosed financial relationships with Bristol Myers Squibb, AbbVie, MSD, Roche, UCB, Pfizer, Eli Lilly, Gebro, Janssen, Sanofi, Gilead, and Adacyte.
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