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lupus SLE

Promising new therapies in SLE

Md Yuzaiful Md Yusof, MRCP(UK), PhD

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

Antoni Chan, MD, PhD

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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Lungs breathing

ILD in RA and PsA

Aurelie Najm, MD, PhD

Interstitial lung disease (ILD) is a severe extra articular manifestation of RA, with limited treatment strategies and poor prognosis.

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EULAR 2023: Featured Industry Presentations

Jack Cush, MD

EULAR 2023 opens tomorrow, Wednesday May 31st, with hundreds of novel presentations and pivotal clinical trials, many being featured industry sponsored clinical trials and research on their novel agents. Below is a collection of the featured abstracts, and presentation times from EULAR

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Colchicine and the Risk of Knee and Hip Replacement

Jack Cush, MD

Treatment of osteoarthritis is a major unmet need, as there are few therapies effective at pain control and no options for disease modification; yet a new trial in Annals of Internal Medicine suggest that chronic low dose colchicine may alter disease progression and lower the risk of of total knee and total hip replacements.

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ANSWER cohort Retrospective study 6600+ bio/tsDMARDs ttmt courses, 20 yrs ✔️IL-6Ri is the lowest discontinued for lack of efficacy ✔️CTLA4-Ig is the lowest discontinued due to AEs ✔️Concomitant GC ⬆️30% drug discontinuation due to AEs @Rheumnow #EULAR23 POS0051 https://t.co/8e6U5KHmX4
Aurelie Najm AurelieRheumo ( View Tweet)
Always great to have @EMA_News to come and to talk to us at #EULAR2023 Our meds are very important to us, and the more we can understand how decisions are made and RWE is collected, the better 👍 @RheumNow https://t.co/hSutraUsFD
David Liew drdavidliew ( View Tweet)
You need to see this! Albert with a Left V1 distribution of #shingles is a ‘bot’ who interacts with #rheumatologists at #EULAR2023 ⁦@RheumNow⁩ ⁦@eular_org⁩ #artificial #intelligence https://t.co/gDwzc3NX7v
Janet Pope Janetbirdope ( View Tweet)
No relationship between MTX-PG levels in terms of efficacy by SDAI remission but higher MTX-PG levels related to adverse events by Tamai H, Abstr #OP0128 #EULAR2023 @RheumNow https://t.co/TiO5eeYlnS
Dr. Antoni Chan synovialjoints ( View Tweet)
The overall risk of cancer and cardiovascular disease were decreased in RA treated with JAKi but there was no comparison with TNFi, Sung Soo Ahn, Abst#00132 #EULAR2023 @RheumNow https://t.co/9Bi6t6uuig
Dr. Antoni Chan synovialjoints ( View Tweet)
JAKi are NOT associated w worse safety vs bDMARDs when adjusting for confounding. Did regulators get it wrong? #EULAR2023 @RheumNow #OP0116 https://t.co/ZNk0NI7Ky5
Janet Pope Janetbirdope ( View Tweet)
#EULAR2023 #OP0137 Most impressive Delta difference vs Control in #lupus! In Phase 3 RCT in China, more patients in Telitacicept, BAFF/APRIL-i met SRI-4 (delta 44% if data imputed; 34% without) vs placebo. No major safety. Global Phase 3 RCT is in progress @RheumNow https://t.co/DUFRQ7pNUA
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
#JAKi May decrease #cancers - age, male, #diabetes had more #cancer but NOT associated w drug prescribed AND LESS #malignancy & LESS #CVE in JAKi vs csDMARDs in huge admin database. Diff from other results OP0140 @RheumNow #EULAR2023 EFFECTIVE Rx of RA LOWERS CVE & cancer w JAKi! https://t.co/oQ3QeUZz3E
Janet Pope Janetbirdope ( View Tweet)
@RheumNow Safety is pretty good too - this is abatacept we are talking about here. Cost is a different question, as is the pharmacoeconomics, but at least it’s safe. One other thing about the study ⬇️ #EULAR2023 @RheumNow https://t.co/H3AdBsK8t9
David Liew drdavidliew ( View Tweet)
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) https://t.co/kk12pa17Nn https://t.co/qEcRatKRSf

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Dr. John Cush RheumNow ( View Tweet)
EULAR PtoC management of targeted therapies in pts w/ IA & Hx cancer 1) If remission, initiate targeted therapy w/out delay 2) Prefer anti-cytokine bDMARDs if Hx solid cancer 3) B cell depleting therapy if Hx lymphoma 4) Use JAK inhibitors and abatacept with caution 🛑 https://t.co/cKhQVZwGh1
Aurelie Najm AurelieRheumo ( View Tweet)
Provan et al. large scandinavian registry study: 🫁ILD risk in RA & PsA initiating b/tsDMARDs HR ILD RA=10 HR ILD PsA=5 No increase risk w/ MTX and b/tsDMARDs but RA HR ILD 1.7 RTX vs. ETA: confounding by indication? https://t.co/CF1ysNkQxU OP0006 #EULAR23 @Rheumnow https://t.co/DgDE1uFeUs

Links:

Aurelie Najm AurelieRheumo ( View Tweet)
New benefit/risk outlook 👀 on ORAL surveillance 2 subgrps: 🟢RA w/ no previous Hx of atherosclerotic CV dis = TOFA at least as good as TNFi AND risk of MACE is comparable 🛑RA w/ HxASCVD = efficacy TOFA = TNFi AND > risk of MACE https://t.co/VOxNQSoyY4 OP0043 #EULAR23 @Rheumnow https://t.co/m98eSMG03U

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Aurelie Najm AurelieRheumo ( View Tweet)
Biosimilar vs originator: as switches loom in the US, once again it’s really hard to say we see any differences in drug survival for our RA patients These data from forced switching in BC, Canada are just like the others - biosimilars are business as usual. POS0567 #EULAR2023 https://t.co/Ebl1hTM4qE
David Liew drdavidliew ( View Tweet)
Ongoing work to #classify #inflammatory #arthritis in Pts using #check #point #inhibitors. A 1st step to study the etiology of immune changes from these life prolonging medications #EULAR2023 @RheumNow https://t.co/Bv1q8IphqF

Links:

Janet Pope Janetbirdope ( View Tweet)

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