%0 Journal Article
%T Abatacept versus other biologics in methotrexate inadequate responders with rheumatoid arthritis: you like tomato and I like tomahto... let's call the whole thing off
%A Yusuf Yazici
%J Arthritis Research & Therapy
%D 2012
%I BioMed Central
%R 10.1186/ar3688
%X In a previous issue of Arthritis Research & Therapy, Patricia Guyot and colleagues present their elegant paper of a meta-analysis comparing abatacept to other biologics in rheumatoid arthritis (RA) patients who had an inadequate response (IR) to methotrexate (MTX) [1]. The authors compare MTX IR studies to see if various biologic agents differ in achieving improvement in function as measured by the Health Assessment Questionnaire, ACR50 and DAS28 < 2.6 responses, all robust measures of improvement. In their analysis, patients had similar responses with abatacept compared to other biologics - etanercept, adalimumab, infliximab, certolizumab, rituximab and tocilizumab - at 24 and 52 weeks. As discussed in the paper, differences of methodology and types of patients enrolled in each individual trial may account for the few differences reported among the biologics. In my opinion, these are not clinically relevant and I agree with the conclusion reached by the authors that similar responses should be expected when these biologics are used for the treatment of RA patients who are MTX-IR.Currently most of the available biologic agents have MTX-IR indications, as these are the patients where a biologic agent would be most commonly used. However, 'MTX-IR' is poorly defined in clinical trials, where it is up to the treating physician to decide what an 'inadequate response' is. Hence, depending on when and where the study was conducted, different types of patients, with different histories of MTX use, dosage and duration, all considered MTX-IR, may be included, and this makes head-to-head comparison difficult. Commonly the disease activity levels are similar at baseline but what really happened to them while on MTX prior to enrollment is not clear. A better comparison would probably be if patients with early RA who are MTX-naive were compared, as these patients would be more likely to be similar in their previous RA treatment and hence lead to more robust comparisons. We previo
%U http://arthritis-research.com/content/14/1/104