Abatacept for Treatment of Rheumatoid Arthritis: Special Focus on the Elderly

Targeted therapies have been developed for patients with rheumatoid arthritis (RA) for whom prior treatment with traditional disease-modifying anti-rheumatic drugs has failed. The numerous different signaling pathways now targeted by various classes of monoclonal antibodies and small molecule inhibitors may complicate treatment decisions. Abatacept selectively modulates a co-stimulatory signal necessary for T-cell activation. Thus, abatacept is effective in biologic-naive patients and in those for whom biologic therapy has failed. Emerging evidence indicates different benefits depending on patient and disease characteristics. In RA, the clinical goal should be clinical and radiographic remission to prevent structural damage and functional impairment. Nevertheless, the management of elderly patients with RA is often less aggressive, and the treat-to-target strategy is less respected in this age category than in the treatment of RA in younger patients. However, abatacept treatment in elderly patients is as effective and well-tolerated as in younger patients. This review summarizes recently published data on pharmacological properties; clinical and biological data on efficacy, drug retention, and safety, focusing on age; and evidence-based criteria for choosing abatacept or an alternative targeted therapy.