Comparative Effectiveness of Abatacept versus Adalimumab in Shared Epitope positive and negative Rheumatoid Arthritis patients

Chuan Fu Yap; Nisha Nair; Seema D Sharma; John Bowes; Amirah Binti Mohammad Ariff; Ann W Morgan; John D Isaacs; Anthony G Wilson; Kimme L Hyrich; Suzan Verstappen; James Bluett; Andrew P Morris; Anne Barton; Darren Plant; Sebastien Viatte

doi:10.1002/art.43298

Comparative Effectiveness of Abatacept versus Adalimumab in Shared Epitope positive and negative Rheumatoid Arthritis patients

Chuan Fu Yap, Nisha Nair, Seema D Sharma, John Bowes, Amirah Binti Mohammad Ariff, Ann W Morgan, John D Isaacs, Anthony G Wilson, Kimme L Hyrich, Suzan Verstappen, James Bluett, Andrew P Morris, Anne Barton, Darren Plant, Sebastien Viatte

Research output: Contribution to journal › Article › peer-review

Abstract

OBJECTIVES: The effect of the shared epitope (SE), and valine at position 11 (Val11) of HLA-DRB1, on the activation of CD4 + T cells, is expected to be diminished by abatacept, a co-stimulation blocker. However, published evidence on the value of genetic stratification for abatacept treatment is conflicting. We aimed to compare the difference in effectiveness of abatacept and adalimumab in patients carrying the SE (or Val11).

METHODS: The Biologics in Rheumatoid Arthritis Genetics and Genomics Study Syndicate is a nationwide observational cohort study recruiting patients from 53 centres across the UK before the initiation of biologic treatment and following them up prospectively for 12 months. 342 patients starting either on abatacept or adalimumab were eligible for this analysis. Serum drug levels for abatacept, adalimumab and methotrexate were determined at multiple time points. Multivariate modelling integrating demographic, clinical and pharmacological variables was used to test for associations between the number of copies of the SE or Val11 with response to treatment (EULAR response; DAS28 remission; change in DAS28). Differential effectiveness between drugs and genetic markers was assessed by the significance of their interaction term.

RESULTS: There was no difference in the efficacy of abatacept versus adalimumab. We found weak evidence for an independent association of genetic markers with response to treatment (Val11 with EULAR response: p-value=0.02), but there was no significant difference in this effect between drugs.

CONCLUSIONS: We find no evidence that HLA-typing is clinically useful to support prescription decisions for these two drugs.

Original language	English
Journal	Arthritis & rheumatology (Hoboken, N.J.)
DOIs	https://doi.org/10.1002/art.43298
Publication status	E-pub ahead of print - 26 Jun 2025

Access to Document

10.1002/art.43298

Cite this

Yap, C. F., Nair, N., Sharma, S. D., Bowes, J., Ariff, A. B. M., Morgan, A. W., Isaacs, J. D., Wilson, A. G., Hyrich, K. L., Verstappen, S., Bluett, J., Morris, A. P., Barton, A., Plant, D., & Viatte, S. (2025). Comparative Effectiveness of Abatacept versus Adalimumab in Shared Epitope positive and negative Rheumatoid Arthritis patients. Arthritis & rheumatology (Hoboken, N.J.). Advance online publication. https://doi.org/10.1002/art.43298

@article{008073b79f7b47c6a3f4c164f364e1c1,

title = "Comparative Effectiveness of Abatacept versus Adalimumab in Shared Epitope positive and negative Rheumatoid Arthritis patients",

abstract = "OBJECTIVES: The effect of the shared epitope (SE), and valine at position 11 (Val11) of HLA-DRB1, on the activation of CD4 + T cells, is expected to be diminished by abatacept, a co-stimulation blocker. However, published evidence on the value of genetic stratification for abatacept treatment is conflicting. We aimed to compare the difference in effectiveness of abatacept and adalimumab in patients carrying the SE (or Val11). METHODS: The Biologics in Rheumatoid Arthritis Genetics and Genomics Study Syndicate is a nationwide observational cohort study recruiting patients from 53 centres across the UK before the initiation of biologic treatment and following them up prospectively for 12 months. 342 patients starting either on abatacept or adalimumab were eligible for this analysis. Serum drug levels for abatacept, adalimumab and methotrexate were determined at multiple time points. Multivariate modelling integrating demographic, clinical and pharmacological variables was used to test for associations between the number of copies of the SE or Val11 with response to treatment (EULAR response; DAS28 remission; change in DAS28). Differential effectiveness between drugs and genetic markers was assessed by the significance of their interaction term.RESULTS: There was no difference in the efficacy of abatacept versus adalimumab. We found weak evidence for an independent association of genetic markers with response to treatment (Val11 with EULAR response: p-value=0.02), but there was no significant difference in this effect between drugs.CONCLUSIONS: We find no evidence that HLA-typing is clinically useful to support prescription decisions for these two drugs.",

author = "Yap, \{Chuan Fu\} and Nisha Nair and Sharma, \{Seema D\} and John Bowes and Ariff, \{Amirah Binti Mohammad\} and Morgan, \{Ann W\} and Isaacs, \{John D\} and Wilson, \{Anthony G\} and Hyrich, \{Kimme L\} and Suzan Verstappen and James Bluett and Morris, \{Andrew P\} and Anne Barton and Darren Plant and Sebastien Viatte",

year = "2025",

month = jun,

day = "26",

doi = "10.1002/art.43298",

language = "English",

journal = "Arthritis \& rheumatology (Hoboken, N.J.)",

issn = "2326-5191",

publisher = "John Wiley \& Sons Ltd",

}

Yap, CF , Nair, N, Sharma, SD, Bowes, J, Ariff, ABM, Morgan, AW, Isaacs, JD, Wilson, AG, Hyrich, KL , Verstappen, S , Bluett, J, Morris, AP, Barton, A , Plant, D & Viatte, S 2025, 'Comparative Effectiveness of Abatacept versus Adalimumab in Shared Epitope positive and negative Rheumatoid Arthritis patients', Arthritis & rheumatology (Hoboken, N.J.). https://doi.org/10.1002/art.43298

TY - JOUR

T1 - Comparative Effectiveness of Abatacept versus Adalimumab in Shared Epitope positive and negative Rheumatoid Arthritis patients

AU - Yap, Chuan Fu

AU - Nair, Nisha

AU - Sharma, Seema D

AU - Bowes, John

AU - Ariff, Amirah Binti Mohammad

AU - Morgan, Ann W

AU - Isaacs, John D

AU - Wilson, Anthony G

AU - Hyrich, Kimme L

AU - Verstappen, Suzan

AU - Bluett, James

AU - Morris, Andrew P

AU - Barton, Anne

AU - Plant, Darren

AU - Viatte, Sebastien

PY - 2025/6/26

Y1 - 2025/6/26

N2 - OBJECTIVES: The effect of the shared epitope (SE), and valine at position 11 (Val11) of HLA-DRB1, on the activation of CD4 + T cells, is expected to be diminished by abatacept, a co-stimulation blocker. However, published evidence on the value of genetic stratification for abatacept treatment is conflicting. We aimed to compare the difference in effectiveness of abatacept and adalimumab in patients carrying the SE (or Val11). METHODS: The Biologics in Rheumatoid Arthritis Genetics and Genomics Study Syndicate is a nationwide observational cohort study recruiting patients from 53 centres across the UK before the initiation of biologic treatment and following them up prospectively for 12 months. 342 patients starting either on abatacept or adalimumab were eligible for this analysis. Serum drug levels for abatacept, adalimumab and methotrexate were determined at multiple time points. Multivariate modelling integrating demographic, clinical and pharmacological variables was used to test for associations between the number of copies of the SE or Val11 with response to treatment (EULAR response; DAS28 remission; change in DAS28). Differential effectiveness between drugs and genetic markers was assessed by the significance of their interaction term.RESULTS: There was no difference in the efficacy of abatacept versus adalimumab. We found weak evidence for an independent association of genetic markers with response to treatment (Val11 with EULAR response: p-value=0.02), but there was no significant difference in this effect between drugs.CONCLUSIONS: We find no evidence that HLA-typing is clinically useful to support prescription decisions for these two drugs.

AB - OBJECTIVES: The effect of the shared epitope (SE), and valine at position 11 (Val11) of HLA-DRB1, on the activation of CD4 + T cells, is expected to be diminished by abatacept, a co-stimulation blocker. However, published evidence on the value of genetic stratification for abatacept treatment is conflicting. We aimed to compare the difference in effectiveness of abatacept and adalimumab in patients carrying the SE (or Val11). METHODS: The Biologics in Rheumatoid Arthritis Genetics and Genomics Study Syndicate is a nationwide observational cohort study recruiting patients from 53 centres across the UK before the initiation of biologic treatment and following them up prospectively for 12 months. 342 patients starting either on abatacept or adalimumab were eligible for this analysis. Serum drug levels for abatacept, adalimumab and methotrexate were determined at multiple time points. Multivariate modelling integrating demographic, clinical and pharmacological variables was used to test for associations between the number of copies of the SE or Val11 with response to treatment (EULAR response; DAS28 remission; change in DAS28). Differential effectiveness between drugs and genetic markers was assessed by the significance of their interaction term.RESULTS: There was no difference in the efficacy of abatacept versus adalimumab. We found weak evidence for an independent association of genetic markers with response to treatment (Val11 with EULAR response: p-value=0.02), but there was no significant difference in this effect between drugs.CONCLUSIONS: We find no evidence that HLA-typing is clinically useful to support prescription decisions for these two drugs.

U2 - 10.1002/art.43298

DO - 10.1002/art.43298

M3 - Article

C2 - 40567118

SN - 2326-5191

JO - Arthritis & rheumatology (Hoboken, N.J.)

JF - Arthritis & rheumatology (Hoboken, N.J.)

ER -

Comparative Effectiveness of Abatacept versus Adalimumab in Shared Epitope positive and negative Rheumatoid Arthritis patients

Abstract

Access to Document

Fingerprint

Cite this