SELECT-GCA suggests JAKis may be the new kid on the block

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Clinicians treating giant cell arteritis (GCA) have long had to contend with a disappointingly limited selection of drugs from which to select. A new group of drugs is finally showing promise in the treatment of GCA.

RIP to Glucocorticoids in GPA

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For many years glucocorticoids were the mainstay of our treatment of granulomatosis with polyangiitis (GPA). The paradigm shifted with cyclophosphamide and then again with rituximab, and we used less steroids, but we still used lots. Avacopan teased the demise of steroids, but in the trial they, and now we, still use them. Glucocorticoids are our old trusty friend, our comfort blanket. But no more! Good riddance to the medication with the highest long-term adverse event burden that we use. Long-term glucocorticoids in GPA should now be a rarity. The reason for such exuberance is the TAPIR study presented by Dr. Peter Merkel at Saturday’s opening plenary session.

TAPIR study of continuing vs stopping steroids in ANCA vasculitis in remission. Relapse at month 6 in 16% vs 4%. OR 4.22, but low rate in either group. If treated Rituximab, no difference! Merkel et al. @RheumNow #ACR24 Abstr#0774 #ACRbest https://t.co/pKa4U5L2fW https://t.co/MjzE14SeGi

Results from SELECT-GCA ➡️UPA 15mg + 26W GC taper demonstrates superior efficacy & reduced GC use vs PBO + 52W GC taper ➡️No new safety signals Is UPA the new kid on the block in #GCA? Ab0770 #ACRBest #ACR24 @RheumNow https://t.co/pHzozYiid5

SELECT-GCA: Upa in GCA Merkel Upa 15 mg v 7.5 v PBO w slower GC taper 70% new onset, 30% relapse. Few prev on IL6 Primary endpt: sustained remission at w52- UPA 15 mg beats PBO (p=0.0019) 34% relapse in UPA vs 60% PBO Less steroids, longer time to flare @RheumNow #ACR24 #ACRBest https://t.co/1OV2889Ny0