Abatacept is the world’s first T-cell selective costimulatory immunomodulator in the field of rheumatic immunity. It can bind to CD80 and CD86 on the surface of antigen-presenting cells to prevent the interaction between the latter and CD28 on the T-cell surface, thus inhibiting T-cell activation, reducing its downstream inflammatory response, and then inhibiting joint injury^[2].

For ACPA-positive rheumatoid arthritis patients, Orencia® has the following advantages:
(1) It is a costimulatory immunomodulator, which can inhibit the overactivation of immune cells, reduce inflammatory reaction and effectively treat rheumatoid arthritis^[1].
(2) It can improve the disease activity of ACPA-positive patients and enable higher treatment response rates (such as ACR20, DAS28, EULAR response). ACPA can be used as a biomarker to predict the efficacy of Abatacept^[3][4].

(3) Long-term use of Abatacept can lower the risk of infection-related hospitalization and incidence of tuberculosis with good level of safety^[5][6][7][8].

References:

[1]  Instructions for Abatacept Injection（NMPA approved version in 2020）

[2] Bonelli M, Scheinecker C. How does abatacept really work in rheumatoid arthritis[J]. Current opinion in rheumatology, 2018, 30(3): 295-300.

[3] Alemao E, Postema R, Elbez Y, et al. Clinical and Experimental Rheumatology, 2019.

[4] J. E. Gottenberg. et al. Arthritis & Rheumatology, Vol. 68, No. 6, June 2016, pp 1346–1352

[5] Chen S K, Liao K P, Liu J, et al. Arthritis Care and Research, 2020, 72(1): 9-17.

[6] Westhovens R, et al. Clin Exp Rheumatol, 2014, 32(4): 553-562.

[7] Genovese M C, et al. The Journal of rheumatology, 2012, 39(8): 1546-1554.

[8] Padovan M, et al.  Arthritis care & research, 2016, 68(6): 738-743.