Monday, 20 May 2019

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ACR 2018 - Day 2 Report

Highlights from Monday, day two of the ACR Annual meeting in Chicago, included:

Paul Klemperer Memorial Lecture

Dr. Joseph Smolen gave this years Klemperer lecture:  entitled " Destructive arthritis: from Progression to Remission and Prevention.”  In this address he said that the “DAS28 is obsolete", as it is too heavily influenced by CRP/ESR, defective for imprescise when using IL-6 inhibitors and has limitations when asessing/ predicting joint damage.  Dr. Smolen pioneered easier metrics including the SDAI and CDAI (tht doesn’t rely on the CRP).  He suggested we must commit to T2T (Treat to Target) because: 1. It allows early intervention and better chance for remission;  2. Evidence that it can prevent joint damage/progression; and  3. Help prevent/minimize disability.  He said “The Way to Treat to Target is also a Target”.  His minimal goal is to reduce RA activity by 50% within 3 months and noted that most damage occur due to delay to therapy.  “Once arthritis damage occurs, it rarely can be reversed.”

Filgotinib in PsA – Abstract 1821

The EQUATOR trial was presented by Dr. Philip Mease. Filgotinib (Fil) is a novel Jak 1 inhibitor that was studied in 131 active Psoriatic arthritis (PsA) patients. The primary endpoint was the ACR20 response at week 16 – this was achieved in 80% of FIL and 33% of placebo (PBO) patients.  FIL was superior to PBO for the ACR50 (48% vs 15%) and ACR70 (23% vs 6%). There were only 2 SAE and the Serious infections were low (1.5%) with only 1 case of H. zoster reported.   Impressive data in an early proof of concept study.

Ixekizumab in Axial Spondyloarthritis  - Abstract 1864

The COAST-V trial was presented by Dr. Désirée van der Heijde that featured the IL-17A inhibitor ixekizumab. The findings of this 16 week study of  341 patients with AxSpA who were randomized to receive PBO, Adalimumab,  Ixekizumab (IXE) q 4 weeks or every 2 weeks.  At 16 wee, superior results were seen for both IXE groups with an ASAS40 response in 52% and 48% compared to 36% on ADA and 18% on PBO. Similar results were seen with BASDAI responses.  MRI assessments showed better improvement in spine SPARCC scores (-9.6 IXE, -11 IXE, -11.6 ADA, -1.5 PBO) than sacroiliac SPARCC scores (-4.3, -4, -4.2, +0.9).  Serious adverse events and serious infections were roughly 1.2% for IXE and there was only 1 case of Candida.  ISRs were 3.7-13% with q4Wk and q2Wk IXE. 


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