Friday, 20 Sep 2019

You are here

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  In this address he said that the “DAS28 is obsolete", as it is too heavily influenced by CRP/ESR, defective for imprescise when using IL-6 inhibitors and has limitations when asessing/ predicting joint damage.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. 


The author has received compensation as an advisor or consultant on this subject

Add new comment

More Like This

NSAID Use Linked With Hypertension in Ankylosing Spondylitis

Continuous use of nonsteroidal anti-inflammatory drugs (NSAIDs) among patients with ankylosing spondylitis (AS) was associated with the development of incident hypertension, a prospective cohort study found.

Anti-IL-23 Beats IL-17 in Plaque Psoriasis

Lancet reports a head-to-head trial of antibodies against interleukin (IL)-23 and IL-17A in patients with moderate-to-severe psoriasis favored guselkumab with superior PASI 90 responses at week 48 (compared to secukinumab).

Taltz FDA Approved for Ankylosing Spondylitis (Radiographic Axial SpA)

The FDA has approved the IL-17A inhibitor Taltz (ixekizumab) for the treatment of adults with active ankylosing spondylitis (AS: also known as radiographic axial spondyloarthritis).  

The recommended dose is 160 mg SC (two 80 mg injections) at Week 0, followed by 80 mg every 4 weeks.  The updated package insert can be found here.

ACR/SPARTAN Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis

The American College of Rheumatology (ACR), in partnership with the Spondylitis Association of America (SAA) and the Spondyloarthritis Research and Treatment Network (SPARTAN), released the 2019 Update of the Recommendations for the Treatment of Ankylosing Spondylitis (AS) and Nonradiographic Axial Spondyloarthritis (nr-axSpA).

Skyrizi Outduels Humira in Psoriasis

A head-to-head trial has shown that risankizumab was significantly superior to adalimumab in providing skin clearance (PASI90) in patients with moderate-to-severe plaque psoriasis, with no difference in safety signals between the two agents.