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Two recent studies suggest there is no significant benefit of early biologics over standard step-up care with methotrexate2,3, but these did not select for poor prognosis.
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Wednesday was Day One at EULAR 2025 in Barcelona. Thousands from around the world gathered, eager to reunite at this international educational forum. Below are a few of my favorites from Day 1.
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Despite the advances in the treatment of PsA with biologic (bDMARD) and targeted synthetic (tsDMARD), less than half of patients with this condition achieved remission or low disease activity. Combination DMARD treatment is often used in order to achieve remission or minimal disease activity. The standard practice is to use a conventional synthetic (csDMARD) with a bDMARD. The use of the combination of bDMARD with a tsDMARD such as a JAKi or TYK2i is a new order in the treatment of PsA.
Antoni Chan MD (Prof)
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Study on the HLAs associated with the occurrence and course of acute/tender dactylitis in PsA patients.
Acute dactylitis genetics:
•HLA-B27 (OR 1.71), HLA-C12 (OR 1.43), B38/C12 & B27/C02 haplotypes.
•Resolution faster on b/tsDMARDs (HR 1.67); unaffected by HLA.
Abstract
Dr. John Cush
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Intraarticular IL-1Ra Gene Therapy in Knee Osteoarthritis
In a dose-escalation trial in nine participants, they observed that a single intra-articular injection of the gene product led to an increase in IL-1Ra in the synovial fluid that remained elevated for up to a year. There https://t.co/qi0qHPd06j
Mrinalini Dey
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#RITAZAREM: infection risk during RTX induction in AAV was ↑ w/ lung disease & nodules/cavities; ↓ w/ TMP-SMX prophylaxis. Early infections predicted later ones, but risk didn’t differ by RTX vs AZA. Pulmonary damage is a key red flag for infection
@RheumNow #EULAR2025 #OP0167
Janet Pope
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#D2T #RA ~20%
#Polyrefractory 3%
Many reasons for d/c ing #Rx - D2T
AEs
Intolerance
Chronic pain
Etc
My approach is different depending on reasons why drugs were d/c
Ie ?obj inflammation vs pain or intolerance
@RheumNow @eular_org #EULAR2025
#whatmakes D2T RA difficult https://t.co/AL6TMVJIk9
Mrinalini Dey
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In #SLE, #HCQ levels >1150 ng/ml ↑toxicity risk w/o added benefit. Levels 750-1150 ng/ml linked to ↓disease activity.
CKD stage ≥3 doubled HCQ levels at same dose.
Supports monitoring & dose adjustment in CKD to balance safety & efficacy.
@RheumNow #EULAR2025 #OP0199
Aurelie Najm
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Combination of LEF and MTX in RA: Yay or Nay?
#EULAR2025 @RheumNow
Jiha Lee
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OP0195: MTX+LEF isn’t commonly used—but could it be a viable option after all?
In >1,100 RA pts, no link to liver fibrosis (FIB-4/APRI), modest ALT ↑, and fewer hospitalizations.
real-world safety data worth a second look.
@RheumNow #EULAR2025
Mrinalini Dey
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ACQUIVAS: RTX-treated AAV patients had poor response to #pneumococcal vaccine PCV-13 (8% vs 45% in non-RTX). Boosting w/ PPV-23 helped a few but 48% failed to mount robust response. Time to rethink vaccine strategies in RTX-treated patients?
@RheumNow #EULAR2025 #OP0173 https://t.co/soU5qfwRib
Mrinalini Dey
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2-year #MANDARA data: Benralizumab shows durable remission, eosinophil suppression & OGC-sparing in EGPA. ~62-68% in remission at wk104. Low relapse rate, no loss of asthma control or decline of lung function. No new safety signals.
@RheumNow #EULAR2025 #OP0166 https://t.co/kXh2q2ilJF
Mrinalini Dey
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In SLEek LTE, ABBV-599 HD (BTKi+JAKi) & UPA 30mg sustained or improved disease control through 104wks: SRI-4 ≥82%, ↓flares, near steroid-free, no new safety signals. PBO-switchers improved too. Targeted oral combos look promising.
@RheumNow #EULAR2025 #OP0198 https://t.co/IHXC2iD0h6
Janet Pope
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#Oninutuzumab works in
#lupus #nephritis #LN
no matter how you vary the
#renal #responses
Of various definitions of
#Complete & #Partial #renal #responses
abst#OP0006
#EULAR25 @eular_org @RheumNow
Not surprised 😲 https://t.co/Zn2lXkddez
Antoni Chan MD (Prof)
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Precision immunotherapy in axial spondyloarthritis: TRBV9xCD3 bispecific antibodies selectively depleted autoreactive TRBV9+ T cells from HLA-B27+ AS patient samples while sparing over 95 percent of the T cell repertoire. TRBV9xCD3 bispecific antibodies selectively depleted https://t.co/8UXqEaDYnS
Nelly ZIADE 🍀
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❓️Is early intensive therapy with combination csDMARDs or TNFi superior to standard step care for the treatment of moderate to severe #psoriatic_arthritis?
🅰️ Yes
🔅Check out the SPEED RCT presented by @DrLauraCoates at #EULAR2025
OP0089
@RheumNow
#Strategy https://t.co/24e7wUV2FB
Jiha Lee
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Can RA be intercepted?
In the ALTO follow-up of the APIPPRA RCT (Cope et al), 1 year of abatacept delayed RA onset by up to 3 years in ACPA+/RF+ individuals. Effect strongest in those with mature autoantibody profiles.
Abstract#OP0004
@RheumNow #EULAR2025 https://t.co/N7YwtYod8w
Janet Pope
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Repurposing drugs to #osteoarthritis
No jewel in the rough!
Most drugs - MTX, colchicine, TNFi, IL1i, etc are NEGATIVE or yield mixed results from diff #RCTs
Not sure this is the way forward for #OA drug discovery 💡
#EULAR2025 @RheumNow @eular_org
Abst#POS565 https://t.co/A6SdXtOo7v
David Liew
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IL-17 inhibition for PMR? In the secukinumab ph2 in GCA (TitAIN), patients with PMR did really well, seemingly outperforming steroid taper in the placebo arm. Real promise, will be great to see how the ph3 in PMR (REPLENISH) goes OP0062 #EULAR2025 @RheumNow https://t.co/cisA0GiUx1
David Liew
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If you successfully taper off DMARDs in RA patients in remission, do you risk bringing new joints in the mix?
Leiden post-hoc trial: these patients don’t do worse than those who never get off drug.
Drug-free remission tricky but new joints not a worry. #EULAR2025 @RheumNow https://t.co/QDxNRPN9f1
