Letter to the Editor
Switch from intravenous to subcutaneous abatacept: Our experience
Cambio de abatacept intravenoso a subcutáneo: experiencia de nuestro centro
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Ovalles-Bonilla, Eduardo Estrada, Indalecio Monteagudo" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Juan Carlos" "apellidos" => "Nieto-González" "email" => array:1 [ 0 => "juancarlos.nietog@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Juan G." "apellidos" => "Ovalles-Bonilla" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Eduardo" "apellidos" => "Estrada" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Indalecio" "apellidos" => "Monteagudo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Psicología, Universidad Camilo José Cela, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Cambio de abatacept intravenoso a subcutáneo: experiencia de nuestro centro" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Since the administration of subcutaneous abatacept (ABA)<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">1,2</span></a> has been approved many patients with rheumatoid arthritis (RA) have had their administration route changed.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> The switch from intravenous to subcutaneous administration route may imply a risk of disease outbreak, which in our centre we decided to control clinically at the time of change, after 3 months and after 12 months. Musculoskeletal ultrasound (MSU) provides more precise information than clinical examination in the assessment of joints and tendons, and we therefore also undertook both baseline ultrasound scans and scans after 3 months.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The clinical activity data in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> showed no differences between the baseline moment and after follow-up at 3 and 12 months. Of the 23 patients with RA, 21 (91.3%) continued in treatment with subcutaneous ABA a year after the switch.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The characteristics of our patents are representative of those attending any rheumatology outpatients department, with a mean age of 63.5 years and mean disease duration of 15.5 years. 65.2% had had other previous treatment with biologics, with a mean of 2.3 biologics. 39.1% had received an additional DMAID and 34.8% a corticoid (mean dose of 3.6<span class="elsevierStyleHsp" style=""></span>mg/day of prednisone).</p><p id="par0020" class="elsevierStylePara elsevierViewall">The administration route of a drug is obviously relevant when choosing treatment, particularly in young patients since they are unable to periodically attend hospital appointments due to their employment. Despite the fact that clinical trials support the safety of ABA administration route changes, clinical practice has reported different results. In fact, results published by other researchers, with 27% of patients who reverted to the intravenous route 3 months after changing, suggest that the risk of clinical worsening of the patient is high. However, only one of our patients changed treatment after 3 months, which tends to confirm that change is not associated with an assumable risk of outbreak.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The change in administration route affects patients treated with ABA and also those treated with other biologics such as tocilizumab. Current trends in the use of biologics are for the use of more subcutaneous than intravenous treatments and there are many patients who have been undergoing intravenous treatment with these drugs for years and who are requesting a more convenient administration route. Our results support the change of administration route as safe, but also highlight the need for strict control when this change is carried out.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Although there were no significant differences in the baseline and 3-month control scans, the use of MSU in our patients enabled us to detect subclinical synovitis in one patient and to change treatment after 3 months, which according to the usual activity markers (DAS-28), may not have happened. We believe that this provides another piece of evidence in favour of using routine MSU in the follow-up of RA patients, and supports the fact that the change of administration route is not associated with an exacerbation of inflammatory activity.</p><p id="par0035" class="elsevierStylePara elsevierViewall">To conclude, the change of administration route of intravenous to subcutaneous ABA maintains efficacy in clinical practice. The application of MSU in monitoring of inflammatory RA activity is a useful tool when taking treatment decisions.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Nieto-González JC, Ovalles-Bonilla JG, Estrada E, Monteagudo I. Cambio de abatacept intravenoso a subcutáneo: experiencia de nuestro centro. Reumatol Clin. 2020;16:187–188.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">DAS-28 PCR: Disease Activity Score of 28 joints; NPJ: number of painful joints; NIJ: number of inflamed joints; CRP: C-reactive protein; IR: interquartile range; ESR: erythrocyte sedimentation rate.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Baseline(<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>22) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Three months(<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>22) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Twelve months(<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>21) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span> value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">DAS-28 PCR (median; RI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.87 (2.24; 4.12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.28 (1.59; 3.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.36 (1.96; 3.79) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.84 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ESR, mm/1st h (median; RI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 (9; 27) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.5 (6; 16.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 (3.5; 17.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.935 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CRP, mg/dl (median; RI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.46 (.26; .74) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.3 (.2; .6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.4 (.2; .6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.45 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NJP (median; RI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (0; 5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.5 (0; 2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0; 7.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.124 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NIJ (median; RI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (0; 1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0; 1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0; 1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.167 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2287809.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Evolution of the activity data and the acute phase reactants after changing administration route.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0025" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Head-to-head comparison of subcutaneous abatacept versus adalimumab for rheumatoid arthritis: two-year efficacy and safety findings from AMPLE trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Schiff" 1 => "M.E. Weinblatt" 2 => "R. Valente" 3 => "D. van der Heijde" 4 => "G. Citera" 5 => "A. Elegbe" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/annrheumdis-2013-203843" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2014" "volumen" => "73" "paginaInicial" => "86" "paginaFinal" => "94" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23962455" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0030" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Subcutaneous abatacept for the treatment of rheumatoid arthritis: longterm data from the ACQUIRE trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.C. Genovese" 1 => "C.P. Tena" 2 => "A. Covarrubias" 3 => "G. Leon" 4 => "E. Mysler" 5 => "M. 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Cavazzana" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3899/jrheum.141042" "Revista" => array:6 [ "tituloSerie" => "J Rheumatol" "fecha" => "2015" "volumen" => "42" "paginaInicial" => "193" "paginaFinal" => "195" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25512476" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735743/00000016000002P2/v2_202005120734/S217357431930070X/v2_202005120734/en/main.assets" "Apartado" => array:4 [ "identificador" => "8400" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735743/00000016000002P2/v2_202005120734/S217357431930070X/v2_202005120734/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217357431930070X?idApp=UINPBA00004M" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 28 | 21 | 49 |
| 2024 September | 23 | 19 | 42 |
| 2024 August | 46 | 35 | 81 |
| 2024 July | 31 | 25 | 56 |
| 2024 June | 32 | 21 | 53 |
| 2024 May | 36 | 21 | 57 |
| 2024 April | 33 | 24 | 57 |
| 2024 March | 26 | 23 | 49 |
| 2024 February | 35 | 37 | 72 |
| 2024 January | 33 | 20 | 53 |
| 2023 December | 19 | 24 | 43 |
| 2023 November | 42 | 45 | 87 |
| 2023 October | 191 | 30 | 221 |
| 2023 September | 72 | 65 | 137 |
| 2023 August | 53 | 28 | 81 |
| 2023 July | 27 | 28 | 55 |
| 2023 June | 41 | 23 | 64 |
| 2023 May | 34 | 25 | 59 |
| 2023 April | 21 | 14 | 35 |
| 2023 March | 42 | 32 | 74 |
| 2023 February | 34 | 24 | 58 |
| 2023 January | 32 | 19 | 51 |
| 2022 December | 50 | 36 | 86 |
| 2022 November | 50 | 32 | 82 |
| 2022 October | 47 | 39 | 86 |
| 2022 September | 39 | 44 | 83 |
| 2022 August | 29 | 30 | 59 |
| 2022 July | 39 | 45 | 84 |
| 2022 June | 26 | 28 | 54 |
| 2022 May | 20 | 28 | 48 |
| 2022 April | 25 | 36 | 61 |
| 2022 March | 29 | 38 | 67 |
| 2022 February | 33 | 30 | 63 |
| 2022 January | 43 | 31 | 74 |
| 2021 December | 29 | 43 | 72 |
| 2021 November | 35 | 49 | 84 |
| 2021 October | 33 | 45 | 78 |
| 2021 September | 24 | 35 | 59 |
| 2021 August | 17 | 26 | 43 |
| 2021 July | 21 | 26 | 47 |
| 2021 June | 16 | 13 | 29 |
| 2021 May | 23 | 44 | 67 |
| 2021 April | 88 | 96 | 184 |
| 2021 March | 35 | 21 | 56 |
| 2021 February | 22 | 15 | 37 |
| 2021 January | 37 | 23 | 60 |
| 2020 December | 31 | 23 | 54 |
| 2020 November | 22 | 19 | 41 |
| 2020 October | 14 | 9 | 23 |
| 2020 September | 32 | 25 | 57 |
| 2020 August | 1 | 1 | 2 |
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