1278 - Abatacept Reduces N-Terminal Pro Brain Natriuretic Peptide Levels in Patients with Rheumatoid Arthritis: Results From a Prospective Cohort Study

Monday, November 7, 2011: 9:00 AM-6:00 PM
Hall F2 - Poster Hall (McCormick Place West)
Inge A.M. van den Oever, Jan van Breemen Research Institute | Reade, Amsterdam, Netherlands and Michael T. Nurmohamed, Reade, Centre for Rehabilitation and Rheumatology, Amsterdam, Netherlands
Presentation Number: 1278

Background/Purpose:

Rheumatoid arthritis (RA) patients are at increased risk of heart failure (HF). The chronic inflammatory state in RA is associated with increased levels of N-terminal pro-brain natriuretic peptide (NT-proBNP), a clinical biomarker for HF. Recently a study has shown that NT-proBNP levels in RA patients decrease under TN-blocking therapy. It is not know whether this is also observed in biologics with another mode of action. Therefore, we investigated the association between EULAR response and change of NT-proBNP during abatacept treatment.

Method:

Of twenty-eight RA patients, treated with abatacept (10mg/kg) every 4 weeks and included in an observational cohort study, disease activity parameters and serum samples were collected at baseline and after 12 and 24 weeks of therapy. Clinical response to abatacept was assessed after 24 weeks of therapy using EULAR response criteria. Responding patients comprised both good and moderate EULAR responders. NT-proBNP levels were measured by the Elecsys 2010 electrochemiluminescence method (Roche diagnostics).

 

Table 1 Baseline characteristics of 28 patients with RA

Demographic variables

Age (years)

53 (16)

Women

86%

RA-related variables

RA duration (years)

16 (4-23)

IgM-RF ≥ 30 IU/ml

68%

erosions on radiographs

68%

nodules

29%

current methotrexate usage

39%

current prednison usage

41%

current usage of other DMARDs

25%

cardiovascular risk factors

prior cardiovascular disease

18%

systolic blood pressure (mm Hg)

134 (17)

diastolic blood pressure (mm Hg)

85 (9)

body mass index (kg/m2)

26 (5)

diabetes mellitus type 2

11%

current smoker

21%

current usage of antihypertensives

36%

current usage of statins

14%

Values are mean (SD), median (IQR) or percentage

Result:

Table 1 shows the baseline characteristics of the 28 RA patients. These characteristics did not differ significantly between EULAR responders and non responders. In all patients, NT-proBNP levels decreased (p= 0.09) after 12 weeks of therapy and decreased  significantly (p=0.04) after 24 weeks of abatacept therapy.(table 2) Out of 28, 19(68%) patients were EULAR responders after 24 weeks of therapy. At baseline NT-proBNP levels were higher in responding patients compared to non-responding patients. After 12 weeks of treatment more decrease in NT-proBNP levels was observed in responding patients compared to non-responders.(table 1). The same tendency was found after 24 weeks of therapy. Univariate analysis demonstrated a significant association between EULAR response and NT-proBNP levels (regression coefficient 1.18, 95%CI 2.18 to 0.19; p=0.022).

 

Table 2. changes in NT-proBNP levels

 

baseline

12 weeks

24 weeks

all patients

9.3 (4.4 - 25.5)

10 (3.8 - 22.2)

9.0 (3.8 - 21.0)*

EULAR responders

22.0 (6.9 - 63.6)

13.3 (5.3 - 34.5)*

17.2 (6.0 - 39.5)*

EULAR non-responders

8.15 (3.5 - 9.7)

4.8 (3.0 - 17.9)*

5.9 ( 2.1 - 9.3)*

P<0.05

Conclusion:

Decrease in NT-proBNP levels was more prominent in patients responding to abatacept therapy compared to non-responding patients. These findings underscore the importance of tight control of systemic inflammation in RA patients in order to decrease CV risk.

 


Keywords: NT-proBNP, abatacept and rheumatoid arthritis (RA)

Disclosure: I. A. M. van den Oever, None; M. T. Nurmohamed, None.