No benefit of prolonged abatacept cessation before joint replacement in RA patients
medwireNews: Among patients with rheumatoid arthritis (RA) undergoing elective joint replacement, stopping intravenous abatacept treatment for more than one dosing interval prior to surgery may not result in better postoperative outcomes than a shorter length of discontinuation, researchers report.
“Guidelines recommend holding biologic therapies before hip and knee arthroplasty, yet evidence to inform optimal timing is limited,” explain Jeffrey Curtis (University of Alabama at Birmingham, USA) and study co-authors.
The team used two US databases to analyze data from 1780 patients who underwent 1939 hip or knee replacements between 2006 and 2015. Abatacept was stopped at least 8 weeks before surgery in 345 cases, between 4 and 8 weeks prior to surgery in 862 cases, and less than one dosing interval (4 weeks) before surgery in 732 procedures.
After propensity score adjustment to balance the groups, rates of infection requiring hospitalization within 30 days of surgery were not significantly different among patients who stopped abatacept at 8 weeks or more, 4–8 weeks, or less than 4 weeks prior to surgery, at 11.9%, 7.8%, and 9.1%, respectively. The risk for prosthetic joint infection in the first year after surgery was also comparable across the groups, with corresponding rates of 7.2%, 5.2%, and 6.2%.
However, the researchers found that patients who discontinued abatacept at least 8 weeks or between 4 and 8 weeks prior to surgery were significantly more likely to have a prolonged duration of hospital stay (>90th percentile) than those with the shortest duration of treatment cessation (odds ratio=2.26 and 1.74, respectively).
Patients who stopped abatacept for the longest period of time were also significantly more likely to be prescribed glucocorticoid treatment in the 90 days following joint replacement surgery than those who discontinued treatment for 4–8 weeks or less than 4 weeks preoperatively, with rates of 49.6% versus 42.0% and 42.5%, respectively.
These results indicate that “[h]olding abatacept may not improve outcomes, particularly if glucocorticoids must be increased to treat disease flares,” write Curtis and team, but they caution that their study was not able to assess disease flares directly.
“Applying these results to clinical practice, it may [be] reasonable pre-operatively to time intravenous abatacept infusions to occur 2-4 weeks prior to surgery,” they conclude in Arthritis Care & Research.
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