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  • May 31, 2023

    EULAR 2023 launched today to crowds of attendees.  The opening Plenary session and presidential address by Dr. Ian McInnes was followed by a number of overview and review sessions with but a half-day of abstracts presentations, on several therapeutic areas including osteoarthritis, JIA, COVID and more.  The following are a few of the presentations that caught my eye.

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Promising new therapies in SLE

The pharmacology treatment in SLE is a rapidly expanding field of research that provides excitement and optimism to both the patients and the clinicians. We now have three licensed targeted therapies (belimumab and voclosporin in active lupus nephritis and anifrolumab in non-renal SLE) over the last 3 years compared to one therapy (belimumab in non-renal SLE) in the previous 50 years. What are other promising therapies on the horizon? 

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An update on JAK inhibitors and cardiovascular risks

May 31, 2023

In the last 2 years, there has been more caution and vigilance with the use of JAK inhibitors in the treatment of rheumatoid arthritis due to the risk of CV events, including MACE and VTE. The ORAL surveillance study, a post-approval safety study conducted in RA patients aged ≥50 years with ≥1 CV risk factor, has resulted in increased caution and greater emphasis on assessment of MACE and VTE risks in patients starting JAK inhibitors. 

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ILD in RA and PsA

Interstitial lung disease (ILD) is a severe extra articular manifestation of RA, with limited treatment strategies and poor prognosis. While for a long time RA treatments, such as methotrexate (MTX), have been considered a risk factor, recent data have shown the innocuity of MTX on lung disease (and in fact suggests it could reduce risk of ILD by increasing disease control and remission).

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#EULAR2023 OP0083-HPR Stretch & Strength training is key! An RCT in Brazil shows: Pilates x 3/week is more effective in reducing pain, HRQoL, psychological effects & analgaesic consumption VS Aerobic walking on treadmill x 3/week for 12 weeks in women with Fibromyalgia @RheumNow
An interesting biomarker in #sJIA- helps differentiate it from other diseases, including infections and other inflammatory diseases! - kids with fever! serum calprotectin (MRP8/14) particle enhanced immuno-turbidimeteic assay (sCAL Turbi). 650 pts @rheumnow #EULAR2023 abst#OP0034
#CPPD and #cervical involvement. Several clinical presentations A-asymptomatic deposition B-crowned dens syndrome C-retro-odontoid pseudotumor D-inflammatory discitis Good teaching points in the supplements! @RheumNow #EULAR2023 Abst#AB1859
Remember to discuss bone density in your pts with #gout! Bone mineral density was significantly lower in pts with hyperuricemia, more so in males and elderly. Large cohort wirh 9017 pts from China! @EULAR2023 @rheumnow abst#AB1639
Gut microbiome studies are implicated in all disease we study! 5 gut microbiota are suggested to have a causal relationship in #gout. 68k controls and 2k gout pts. Can experts comment if it's just data mining or discovery? #EULAR2023 @rheumnow abst#ab1237
#EULAR2023 #OP0046 With more effective therapies in #lupus, we should aim for bare minimum/cessation of steroid. A study using French database showed: >12% were on =>5mg Pred/d, this associated with comorbidities & increased costs 14% on high dose Pred weren’t on HCQ @RheumNow
#EULAR2023 #OP0007 What are the recent trends of autoimmune disease (AID)? A database study (22m) in UK showed: - 1 in 10 people had AID in the last 20yrs - socioeconomic, seasonal & regional disparities cd influence pathogenesis - CTD (SLE,pSS,SSc) tended to co-occur @RheumNow
Medication adherence in #lupus - assessed using Optum administrative database 14 yrs. 12510 pts. Median copays were less than $ 10. Black and hispanics had significantly lower odds of adherence after adjusting for several SDOH! @rheumnow #EULAR2023 abst#AB0579
Chinese study 43 axSpA pts Rx w/ Secukinumab-37 pts had HBV & 16% (6) reactivated HBV after mean 9 mos of SEC (5 w/ chronic HBV, 1 occult HBV). 2 pts chronic HBV reactivated despite anti-HBV prophylaxis. 6 axSpA w/ LTBI - none had TB on SEC
May 31, 2023
Randomized double blind, placebo controlled MTX trial in inflammatory #handOA - pts with MrI detected synovitis. 97 pts 20mg MTX helped reduce pain and stiffness at 6 months. @rheumnow #EULAR2023 abst#OP0070 Early work with some promise!
Interesting newer potential theraputics in #handOA discussed at #EULAR2023 - denosumab had clear structure modifying effects in erosive habd OA compared to placebo. Monocentric, placebo controlled, doubke blind phase 2 study of 100 pts. @rheumnow abst#OP0071
Recruitment in clinical trials is tough in #lupus and #CTD. A #EULAR2023 study of 49 trials, 1909 records- in an unselected, real world cohort of #CTD pts, upto 50% would be excluded due to classification criteria or overlapping features etc! Abst#op0013 @RheumNow
Colchicine 0.5mg BID for 12 weeks in #HandOA did not relieve pain. Results from 186 pts- double blind placebo controlled, randomized. MCID on VAS of 15 was not achieved. Presented at #EULAR2023 today abst#op0073 @RheumNow
Metanalysis of 62 RCTs, 16 LTEs, 82 366 Pt-Yrs JAK exposure. JAKi malignancy incid rate = 1.15/100 PYs in RCTs (1.26/100PYs overall). Network meta-analyses show no diff betw JAK & PBO or MTX in NMSC, but signif increased malignancy risk (IRR 1.50)
May 31, 2023
Swiss Clinical Quality Management cohort 1200+ PsA pts: Overweight 27% & Obesity 37% PsA > 11% vs. 30% general pop Obesity ⬆️ over time in males only Socio economic status NOT associated w/ risk in PsA population vs. general pop OP0064 #EULAR23 @Rheumnow
Diagnosing spondylitis is a pain in the ‘butt’! #EULAR2023 OP0005 studied an inception cohort of incident chronic low back pain followed for 2 yrs. Of pts referred to #rheumatologist, 1/3 had dx of axSpA, but clinical features alone didn’t; imaging did. @RheumNow OP0005
ICYMI: The Biosimilar "Buy In" In 2023, we are expecting 17 biosimilars in rheumatology. While some pharmaceutical company and payer contracts are still under negotiation, we need to start preparing ourselves and our patients.
May 31, 2023