Retention of subcutaneous abatacept for the treatment of rheumatoid arthritis: real-world results from the ASCORE study: an international 2-year observational study

Rieke Alten, Xavier Mariette, René-Marc Flipo, Roberto Caporali, Maya H Buch, Yusuf Patel, Sara Marsal, Raimon Sanmartí, Michael T Nurmohamed, Hedley Griffiths, Peter Peichl, Bettina Bannert, Melanie Chartier, Sean E Connolly, Karissa Lozenski, Christiane Rauch, Rieke Alten, Xavier Mariette, René-Marc Flipo, Roberto Caporali, Maya H Buch, Yusuf Patel, Sara Marsal, Raimon Sanmartí, Michael T Nurmohamed, Hedley Griffiths, Peter Peichl, Bettina Bannert, Melanie Chartier, Sean E Connolly, Karissa Lozenski, Christiane Rauch

Abstract

Objectives: To evaluate retention, efficacy, and safety of subcutaneous (SC) abatacept over 2 years in patients with moderate-to-severe RA in the Abatacept SubCutaneOus in Routine clinical practicE (ASCORE) study.

Methods: Patients with RA who initiated SC abatacept 125 mg once weekly were enrolled in the international, observational, prospective multicentre ASCORE study into biologic-naïve or ≥ 1 prior biologic failure cohorts.

Primary endpoint: abatacept retention rate at 2 years. Secondary endpoints: proportion of patients with good/moderate EULAR response rates based on DAS28 (ESR), low disease activity and/or remission according to DAS28 (ESR; ≤ 3.2/ < 2.6), SDAI (≤ 11/ ≤ 3.3), CDAI (≤ 10/ ≤ 2.8), and Boolean criteria. Retention rate by baseline serostatus was evaluated post hoc.

Results: Overall, 47% of patients remained on abatacept for 2 years, irrespective of treatment line. Higher abatacept retention rates were associated with lower prior biologic exposure. Generally, clinical outcomes showed that the proportion of patients with low disease activity/remission was higher in biologic-naïve patients (vs biologic-failure) and similar in those with 1 and ≥ 2 prior biologic failures. In patients on treatment at 2 years, good/moderate EULAR response rates of ~ 80% were consistently noted irrespective of prior biologic exposure. Across treatment lines, retention was greater in patients with seropositive (vs seronegative) RA. Patients with rheumatoid factor/anti-citrullinated protein antibody single-positive RA who were bio-naïve had higher retention than patients who were bio-experienced.

Conclusions: In the ASCORE study, SC abatacept retention was 47% at 2 years with good clinical outcomes and was well-tolerated in the real-world setting. Abatacept retention and clinical response rates were higher in patients who received abatacept as an earlier- versus later-line biologic drug treatment and in those with seropositive RA.

Trial registration: ClinicalTrials.gov, NCT02090556.

Keywords: Abatacept; Biological therapy; Retention; Rheumatoid arthritis.

Conflict of interest statement

CR, MC, KL, and SEC are employees and shareholders of Bristol Myers Squibb. BB, YP, and PP have no competing interests. SMB declares consulting/grant/research support/speaker fees from AbbVie, Bristol Myers Squibb, Gilead/Galapagos, Janssen, MSD, Novartis, Pfizer, Roche, Sandoz, Sanofi, and UCB. MHB declares consulting/grant/research support from AbbVie, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, EMD Serono, Pfizer, Roche, Sanofi, and UCB. RC declares consulting and speaker fees from AbbVie, Amgen, Bristol Myers Squibb, Celltrion, Fresenius Kabi, Gilead/Galapagos, Eli Lilly, MSD, Pfizer, Roche, Sanofi, and UCB. R-MF declares consulting and speaker fees from AbbVie, Bristol Myers Squibb, Eli Lilly, MSD, Pfizer, Roche-Chugai, and Sanofi. HG declares consulting/research support/speaker fees from AbbVie, Gilead, Pfizer, and Roche. XM declares honoraria from Bristol Myers Squibb, Galapagos, Gilead, GSK, Janssen, Novartis, Pfizer, and UCB. MN declares consulting/grant/research support/speaker fees from AbbVie, Bristol Myers Squibb, Celgene, Celltrion, Eli Lilly, Galapagos, Janssen, MSD, Mundipharma, Novartis, Pfizer, Roche, and Sanofi. RS declares consulting/grant support from AbbVie, Bristol Myers Squibb, Fresenius, Gebro Pharma, Gilead/Galapagos, Eli Lilly, Pfizer, Roche, Sandoz, and Sanofi. RA declares speaker fees from AbbVie, Amgen, Bristol Myers Squibb, Celltrion, Galapagos, Gilead, Eli Lilly, Novartis, Pfizer, and Roche. Consulting fees from Celltrion, Galapagos, Gilead, Eli Lilly, and Novartis. Research support from Bristol Myers Squibb, Galapagos, Gilead, Novartis, and Pfizer.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Patient disposition. aPatients with no recorded date of consent or date of visit 1. IV, intravenous
Fig. 2
Fig. 2
Proportion of patients with subcutaneous abatacept retention over 2 years by treatment linea: A overall, B biologic-naïve, and C ≥ 1 prior biologic failure.b aPatients who switched to IV abatacept during the 2 years were discontinued and are not included. bFirst line or more data present combined data from patients with 1 and ≥ 2 failures of prior biologic treatment, as further stratification would result in small patient numbers. Panels B and C reproduced from Alten R, et al. EULAR Virtual Congress 2021; 3 June 2021; oral presentation OP0180 (with permission from the authors). CI, confidence interval; KM, Kaplan–Meier; IV, intravenous; RA, rheumatoid arthritis
Fig. 3
Fig. 3
Clinical outcomes at 2 years by treatment line. DAS28, Disease Activity Score in 28 joints; CDAI, Clinical Disease Activity Index; ESR, erythrocyte sedimentation rate; EULAR, European League Against Rheumatism; SDAI, Simplified Disease Activity Index
Fig. 4
Fig. 4
SDAI and CDAI A LDA/remission and B remission at 2 years by serostatus and treatment line (last observation carried forward). Figure reproduced from Alten R, et al. EULAR Virtual Congress 2021; 3 June 2021; oral presentation OP0180 (with permission from the authors). CDAI, Clinical Disease Activity Index; LDA, low disease activity; RA, rheumatoid arthritis; SDAI, Simplified Disease Activity Index

References

    1. Combe B. Progression in early rheumatoid arthritis. Best Pract Res Clin Rheumatol. 2009;23:59–69. doi: 10.1016/j.berh.2008.11.006.
    1. Katchamart W, Koolvisoot A, Aromdee E, Chiowchanwesawakit P, Muengchan C. Associations of rheumatoid factor and anti-citrullinated peptide antibody with disease progression and treatment outcomes in patients with rheumatoid arthritis. Rheumatol Int. 2015;35:1693–1699. doi: 10.1007/s00296-015-3271-8.
    1. Singh JA, Saag KG, Bridges SL, Jr, Akl EA, Bannuru RR, Sullivan MC, Vaysbrot E, McNaughton C, Osani M, Shmerling RH, Curtis JR, Furst DE, Parks D, Kavanaugh A, O'Dell J, King C, Leong A, Matteson EL, Schousboe JT, Drevlow B, Ginsberg S, Grober J, St Clair EW, Tindall E, Miller AS, McAlindon T. 2015 American College of Rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis Care Res. 2016;68:1–26. doi: 10.1002/art.39480.
    1. Smolen JS, Landewe RBM, Bijlsma JWJ, Burmester GR, Dougados M, Kerschbaumer A, McInnes IB, Sepriano A, van Vollenhoven RF, de Wit M, Aletaha D, Aringer M, Askling J, Balsa A, Boers M, den Broeder AA, Buch MH, Buttgereit F, Caporali R, Cardiel MH, De Cock D, Codreanu C, Cutolo M, Edwards CJ, van Eijk-Hustings Y, Emery P, Finckh A, Gossec L, Gottenberg JE, Hetland ML, Huizinga TWJ, Koloumas M, Li Z, Mariette X, Muller-Ladner U, Mysler EF, da Silva JAP, Poor G, Pope JE, Rubbert-Roth A, Ruyssen-Witrand A, Saag KG, Strangfeld A, Takeuchi T, Voshaar M, Westhovens R, van der Heijde D. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update. Ann Rheum Dis. 2020;79:685–699. doi: 10.1136/annrheumdis-2019-216655.
    1. Malmstrom V, Catrina AI, Klareskog L. The immunopathogenesis of seropositive rheumatoid arthritis: from triggering to targeting. Nat Rev Immunol. 2017;17:60–75. doi: 10.1038/nri.2016.124.
    1. Genovese MC, Covarrubias A, Leon G, Mysler E, Keiserman M, Valente R, Nash P, Simon-Campos JA, Porawska W, Box J, Legerton C, III, Nasonov E, Durez P, Aranda R, Pappu R, Delaet I, Teng J, Alten R. Subcutaneous abatacept versus intravenous abatacept: a phase IIIb noninferiority study in patients with an inadequate response to methotrexate. Arthritis Rheumatol. 2011;63:2854–2864. doi: 10.1002/art.30463.
    1. Genovese MC, Schiff M, Luggen M, Becker JC, Aranda R, Teng J, Li T, Schmidely N, Le BM, Dougados M. Efficacy and safety of the selective co-stimulation modulator abatacept following 2 years of treatment in patients with rheumatoid arthritis and an inadequate response to anti-tumour necrosis factor therapy. Ann Rheum Dis. 2008;67:547–554. doi: 10.1136/ard.2007.074773.
    1. Westhovens R, Kremer J, Emery P, Russell A, Alten R, Barre E, Dougados M. Long-term safety and efficacy of abatacept in patients with rheumatoid arthritis and an inadequate response to methotrexate: a 7-year extended study. Clin Exp Rheumatol. 2014;32:553–562.
    1. Gottenberg JE, Ravaud P, Cantagrel A, Combe B, Flipo RM, Schaeverbeke T, Houvenagel E, Gaudin P, Loeuille D, Rist S, Dougados M, Sibilia J, Le Loet X, Marcelli C, Bardin T, Pane I, Baron G, Mariette X. Positivity for anti-cyclic citrullinated peptide is associated with a better response to abatacept: data from the ‘Orencia and Rheumatoid Arthritis’ registry. Ann Rheum Dis. 2012;71:1815–1819. doi: 10.1136/annrheumdis-2011-201109.
    1. Alten R, Nüßlein H, Galeazzi M, Lorenz HM, Mariette X, Cantagrel A, Chartier M, Elbez Y, Rauch C, Le Bars M. Do predictors of IV abatacept retention depend on the line of rheumatoid arthritis treatment: 12-month interim analysis of the observational, prospective ACTION study. Ann Rheum Dis. 2016;75:202. doi: 10.1136/annrheumdis-2016-eular.6326.
    1. Yoshida K, Radner H, Kavanaugh A, Sung YK, Bae SC, Kishimoto M, Matsui K, Okada M, Tohma S, Weinblatt ME, Solomon DH. Use of data from multiple registries in studying biologic discontinuation: challenges and opportunities. Clin Exp Rheumatol. 2013;31(4 Suppl 78):S28–S32.
    1. Vashisht P, Sayles H, Cannella AC, Mikuls TR, Michaud K. Generalizability of patients with rheumatoid arthritis in biologic agent clinical trials. Arthritis Care Res (Hoboken) 2016;68:1478–1488. doi: 10.1002/acr.22860.
    1. Alten R, Mariette X, Buch M, Caporali R, Flipo R-M, Forster A, Nurmohamed M, Patel Y, Peichl P, Sanmarti R, Chartier M, Heitzmann J, Rauch C, Connolly S (2019) ASCORE, a 2-year, observational, prospective multicentre study of subcutaneous abatacept for the treatment of rheumatoid arthritis in routine clinical practice: 1-year interim analysis. Ann Rheum Dis 78(Suppl 2):1639. Abstract AB0361
    1. Alten R, Mariette X, Buch M, Caporali R, Flipo R-M, Forster A, Nurmohamed M, Patel Y, Peichl P, Sanmarti R, Chartier M, Heitzmann J, Rauch C, Connolly SE (2018) Experience with subcutaneous abatacept in routine clinical practice: 6-month interim analysis of a 2-year, prospective, non-interventional, multicentre study in patients with RA. Ann Rheum Dis 77(Suppl 2):1392. Abstract AB0461
    1. (1997) World Medical Association Declaration of Helsinki. Recommendations guiding physicians in biomedical research involving human subjects. JAMA 277:925–926
    1. (2001) ICH harmonised tripartite guideline guideline for good clinical practice. J Postgrad Med 47:199–203
    1. International Society for Pharmacoepidemiology (2016) Guidelines for good pharmacoepidemiology practices (GPP). 2020. . Accessed July 1, 2020
    1. Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO 3rd, Birnbaum NS, Burmester GR, Bykerk VP, Cohen MD, Combe B, Costenbader KH, Dougados M, Emery P, Ferraccioli G, Hazes JM, Hobbs K, Huizinga TW, Kavanaugh A, Kay J, Kvien TK, Laing T, Mease P, Menard HA, Moreland LW, Naden RL, Pincus T, Smolen JS, Stanislawska-Biernat E, Symmons D, Tak PP, Upchurch KS, Vencovsky J, Wolfe F, Hawker G (2010) 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum 62:2569–2581
    1. Felson DT, Smolen JS, Wells G, Zhang B, van Tuyl LH, Funovits J, Aletaha D, Allaart CF, Bathon J, Bombardieri S, Brooks P, Brown A, Matucci-Cerinic M, Choi H, Combe B, de Wit M, Dougados M, Emery P, Furst D, Gomez-Reino J, Hawker G, Keystone E, Khanna D, Kirwan J, Kvien TK, Landewe R, Listing J, Michaud K, Martin-Mola E, Montie P, Pincus T, Richards P, Siegel JN, Simon LS, Sokka T, Strand V, Tugwell P, Tyndall A, van der Heijde D, Verstappen S, White B, Wolfe F, Zink A, Boers M. American College of Rheumatology/European League against Rheumatism provisional definition of remission in rheumatoid arthritis for clinical trials. Ann Rheum Dis. 2011;70:404–413. doi: 10.1136/ard.2011.149765.
    1. Liu P-C, Ssu C-T, Tsao Y-P, Liou T-L, Tsai C-Y, Chou C-T, Chen M-H, Leu C-M. Cytotoxic T lymphocyte-associated antigen-4-Ig (CTLA-4-Ig) suppresses Staphylococcus aureus-induced CD80, CD86, and pro-inflammatory cytokine expression in human B cells. Arthritis Res Ther. 2020;22:64. doi: 10.1186/s13075-020-2138-x.
    1. Finckh A, Gomez-Reino J, Iannone F, Lie E, Canhao H, Pavelka K, Turesson C, Mariette X, Gottenberg JE, Hetland M, ABA oboP-E-Ro (2014) The impact of DMARD co-therapy on abatacept effectiveness in rheumatoid arthritis patients. A pan-European analysis of RA registries. Ann Rheum Dis 73(Suppl 2):492–493. Abstract FRI0298. 10.1136/annrheumdis-2014-eular.3004
    1. Finckh A, Neto D, Iannone F, Loza E, Lie E, van Riel P, Hetland ML, Pavelka K, Gottenberg JE, Canhão H, Mariette X, Turesson C (2015) The impact of patient heterogeneity and socio-economic factors on abatacept retention in rheumatoid arthritis across nine European countries. RMD Open 1:e000040
    1. Gottenberg JE, Morel J, Perrodeau E, Bardin T, Combe B, Dougados M, Flipo RM, Saraux A, Schaeverbeke T, Sibilia J, Soubrier M, Vittecoq O, Baron G, Constantin A, Ravaud P, Mariette X, French Society of Rheumatology and the investigators participating in AIR, ORA, and REGATE registries Comparative effectiveness of rituximab, abatacept, and tocilizumab in adults with rheumatoid arthritis and inadequate response to TNF inhibitors: prospective cohort study. BMJ. 2019;364:l67. doi: 10.1136/bmj.l67.
    1. Alten R, Mariette X, Lorenz HM, Nusslein H, Galeazzi M, Navarro F, Chartier M, Heitzmann J, Poncet C, Rauch C, Le Bars M. Predictors of abatacept retention over 2 years in patients with rheumatoid arthritis: results from the real-world ACTION study. Clin Rheumatol. 2019;38:1413–1424. doi: 10.1007/s10067-019-04449-w.
    1. Alten R, Mariette X, Lorenz HM, Galeazzi M, Cantagrel A, Nusslein HG, Chartier M, Elbez Y, Rauch C, Le Bars M. Real-world predictors of 12-month intravenous abatacept retention in patients with rheumatoid arthritis in the ACTION observational study. RMD Open. 2017;3:e000538. doi: 10.1136/rmdopen-2017-000538.
    1. Nüßlein HG, Alten R, Galeazzi M, Lorenz HM, Nurmohamed MT, Bensen WG, Burmester GR, Peter HH, Peichl P, Pavelka K, Chartier M, Poncet C, Rauch C, Le BM. Efficacy and prognostic factors of treatment retention with intravenous abatacept for rheumatoid arthritis: 24-month results from an international, prospective, real-world study. Clin Exp Rheumatol. 2016;34:489–499.
    1. Salmon JH, Letarouilly JG, Goëb V, Kanagaratnam L, Coquerelle P, Guyot MH, Houvenagel E, Lecuyer N, Marguerie L, Morel G, Baudens G, Gervais E, Flipo RM. Actual persistence of abatacept in rheumatoid arthritis: results of the French-Ric network. J Clin Med. 2020;9:1528. doi: 10.3390/jcm9051528.
    1. Genovese MC, Pacheco-Tena C, Covarrubias A, Leon G, Mysler E, Keiserman M, Valente R, Nash P, Simon-Campos JA, Box J, Legerton CW, III, Nasonov E, Durez P, Delaet I, Teng J, Alten R. Subcutaneous abatacept for the treatment of rheumatoid arthritis: longterm data from the ACQUIRE trial. J Rheumatol. 2014;41:629–639. doi: 10.3899/jrheum.130112.
    1. Schiff M, Keiserman M, Codding C, Songcharoen S, Berman A, Nayiager S, Saldate C, Aranda R, Becker JC, Nys M, Le BM, Reed DM, Poncet C, Dougados M. Clinical response and tolerability to abatacept in patients with rheumatoid arthritis previously treated with infliximab or abatacept: open-label extension of the ATTEST Study. Ann Rheum Dis. 2011;70:2003–2007. doi: 10.1136/annrheumdis-2011-200316.
    1. Schiff M, Weinblatt ME, Valente R, van der Heijde D, Citera G, Elegbe A, Maldonado M, Fleischmann R. Head-to-head comparison of subcutaneous abatacept versus adalimumab for rheumatoid arthritis: two-year efficacy and safety findings from AMPLE trial. Ann Rheum Dis. 2014;73:86–94. doi: 10.1136/annrheumdis-2013-203843.
    1. Manara M, Caporali R, Favalli EG, Grosso V, Atzeni F, Sarzi Puttini P, Gorla R, Bazzani C, Fusaro E, Pellerito R, Rocchetta PA, Sinigaglia L. Two-year retention rate of golimumab in rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis: data from the LORHEN registry. Clin Exp Rheumatol. 2017;35:804–809.
    1. Baganz L, Richter A, Kekow J, Bussmann A, Krause A, Stille C, Listing J, Zink A, Strangfeld A. Long-term effectiveness of tocilizumab in patients with rheumatoid arthritis, stratified by number of previous treatment failures with biologic agents: results from the German RABBIT cohort. Rheumatol Int. 2018;38:579–587. doi: 10.1007/s00296-017-3870-7.
    1. Ebina K, Hashimoto M, Yamamoto W, Hirano T, Hara R, Katayama M, Onishi A, Nagai K, Son Y, Amuro H, Yamamoto K, Maeda Y, Murata K, Jinno S, Takeuchi T, Hirao M, Kumanogoh A, Yoshikawa H. Drug tolerability and reasons for discontinuation of seven biologics in 4466 treatment courses of rheumatoid arthritis—the ANSWER cohort study. Arthritis Res Ther. 2019;21:91. doi: 10.1186/s13075-019-1880-4.
    1. Favalli EG, Sinigaglia L, Becciolini A, Grosso V, Gorla R, Bazzani C, Atzeni F, Sarzi Puttini PC, Fusaro E, Pellerito R, Caporali R. Two-year persistence of golimumab as second-line biologic agent in rheumatoid arthritis as compared to other subcutaneous tumor necrosis factor inhibitors: real-life data from the LORHEN registry. Int J Rheum Dis. 2018;21:422–430. doi: 10.1111/1756-185X.13199.
    1. Notario Ferreira I, Ferrer Gonzalez MA, Morales Garrido P, Gonzalez Utrilla A, Garcia Sanchez A, Soto Pino MJ, Suero Rosario E, Caro Hernandez C, Anon Onate I, Perez Albaladejo L, Caliz Caliz R. Two-year efficacy of tocilizumab in patients with active rheumatoid arthritis in clinical practice. Reumatol Clin. 2017;13:78–84. doi: 10.1016/j.reuma.2016.03.014.
    1. Ogawa N, Ohashi H, Ota Y, Kobori K, Suzuki M, Tsuboi S, Hayakawa M, Goto Y, Karahashi T, Kimoto O, Miyamoto T, Furukawa S, Shimoyama K, Suzuki D, Maekawa Y. Multicenter, observational clinical study of abatacept in Japanese patients with rheumatoid arthritis. Immunol Med. 2019;42:29–38. doi: 10.1080/25785826.2019.1605036.
    1. Mori S, Yoshitama T, Ueki Y. Tofacitinib therapy for rheumatoid arthritis: a direct comparison study between biologic-naive and experienced patients. Intern Med. 2018;57:663–670. doi: 10.2169/internalmedicine.9341-17.
    1. Greenberg JD, Reed G, Decktor D, Harrold L, Furst D, Gibofsky A, Dehoratius R, Kishimoto M, Kremer JM. A comparative effectiveness study of adalimumab, etanercept and infliximab in biologically naive and switched rheumatoid arthritis patients: results from the US CORRONA registry. Ann Rheum Dis. 2012;71:1134–1142. doi: 10.1136/annrheumdis-2011-150573.
    1. Gottenberg JE, Neto D, Gomez-Reino J, Iannone F, Lie E, Canhao H, Pavelka K, Turesson C, Hetland M, Mariette X, Finckh A (2014) Positivity for rheumatoid factor and anti-cyclic citrullinated peptide is associated with better drug retention of abatacept: data from a pan-European analysis of RA registries. Ann Rheum Dis 73 (Suppl 2):502. Abstract FRI0322
    1. Sarmiento-Monroy JC, Parada-Arias L, Rodriguez-Lopez M, Rodriguez-Jimenez M, Molano-Gonzalez N, Rojas-Villarraga A, Mantilla RD. Subcutaneous abatacept in rheumatoid arthritis: a real-life experience. J Transl Autoimmun. 2019;2:100016. doi: 10.1016/j.jtauto.2019.100016.
    1. Lauper K, Mongin D, Iannone F, Klami Kristianslund E, Kvien TK, Nordstrom D, Pavelka K, Pombo-Suarez M, Rotar Z, Santos MJ, Codreanu C, Lukina G, Courvoisier DS, Gabay C. Comparative effectiveness of subcutaneous tocilizumab versus intravenous tocilizumab in a pan-European collaboration of registries. RMD Open. 2018;4:e000809. doi: 10.1136/rmdopen-2018-000809.
    1. Burmester GR, Rubbert-Roth A, Cantagrel A, Hall S, Leszczynski P, Feldman D, Rangaraj MJ, Roane G, Ludivico C, Bao M, Rowell L, Davies C, Mysler EF. Efficacy and safety of subcutaneous tocilizumab versus intravenous tocilizumab in combination with traditional DMARDs in patients with RA at week 97 (SUMMACTA) Ann Rheum Dis. 2016;75:68–74. doi: 10.1136/annrheumdis-2015-207281.
    1. Desplats M, Pascart T, Jelin G, Norberciak L, Philippe P, Houvenagel E, Goeb V, Flipo RM. Are abatacept and tocilizumab intravenous users willing to switch for the subcutaneous route of administration? A questionnaire-based study. Clin Rheumatol. 2017;36:1395–1400. doi: 10.1007/s10067-017-3587-8.
    1. Wells AF, Jodat N, Schiff M. A critical evaluation of the role of subcutaneous abatacept in the treatment of rheumatoid arthritis: patient considerations. Biologics. 2014;8:41–55.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren