Drug Safety

Most patients with early, active axial spondyloarthritis (axSpA) who quickly received a tumor necrosis factor (TNF) inhibitor experienced remission, and it didn't matter whether or not they had intestinal inflammation at baseline, a small single-arm study found.

Dr. Jack Cush reviews highlights, trends and novel studies from EULAR 2025 in Barcelona from last week.

JAK inhibitors have taken a beating over the last three years. The excitement and potential has been tempered by mounting cardiovascular safety concerns, but specifically in at-risk patients, compared to TNF inhibitors. So it is an intriguing idea to pair JAK inhibitors with something that might have a cardioprotective effect. It is therefore worth excitement that we have a therapeutic option to follow which does just that. At EULAR 2025, we

Nerandomilast, an inhibitor of phosphodiesterase 4B, orally administered, is a new mechanism of action to treat lung fibrotic diseases. FIBRONEER-ILD, the Phase 3 RCT of Nerandomilast in patients with progressive pulmonary fibrosis, was published in NEJM last month.

Women with antiphospholipid syndrome and lupus anti-coagulant are at high risk of developing adverse pregnancy outcomes (APO). Usual care includes low molecular weight heparin (LMWH) and low dose aspirin (LDA). Despite these therapies, APO have been reported up to 40%. An important question is whether add-on immunosuppressive therapy could improve APO.

New studies shared at the 2025 annual EULAR congress in Barcelona highlight the benefits that nurse-led care can bring for both patients and healthcare systems.

Guidelines differ on the early treatment of RA – ACR suggests not to use glucocorticoids (GC) and EULAR updated recommendations for RA treatment presented at #EULAR2025 continued to suggest early treatment with MTX and glucocorticoids. We do know that it is not easy to get a significant minority of RA patients off of prednisone.

I asked the EULAR twitter sphere how they feel about combination of methotrexate (MTX) and leflunomide (LEF). The opinions are differing so far, with 50% reporting prescribing this combination often while 50% are worried of side effects. Several abstracts presented this year are providing further data to help us make up our minds in RA and PsA.

At the 2025 EULAR congress in Barcelona, Prof Dimitrios Boumpas presented a summary of the updated EULAR recommendations on the management of lupus nephritis (LN). The most significant change in the treatment paradigm of LN is that the historic standard of care (SOC) (i.e. mycophenolate with glucocorticoids, GC) is now known to be inferior to several licensed combinations, as well as other unlicensed combination therapies.

To address this, a French multi-centre prospective pregnancy observational cohort was set up, to analyse disease activity, treatment, pregnancy outcomes, delivery, and neonatal health. The work – presented at the 2025 annual congress of EULAR – showcased findings from 97 women with an autoinflammatory disease.

Highlights from today included presentations on imaging in vasculitis, a debate on whether to treat high risk pre-clinical RA, and EULAR Recommendations on a) Treatment of interstitial lung disease (ILD); b) Physical Activity in people with arthritis; and c) EULAR disease activity score for antiphospholipid syndrome and d) the management of SLE nephritis. Below are a few others that caught my eye today.

New work presented at the 2025 annual EULAR congress in Barcelona focuses on the recombinant zoster vaccine (RZV), which contains recombinant glycoprotein E – the major target of CD4+T-cells. The abstract describes the tolerability and safety of RZV in patients with inflammatory rheumatic and musculoskeletal diseases (iRMD), showcasing interim data from an ongoing study.

Is there a higher risk of cancer that comes with the disease? Or with the treatments? So many confounding parameters, such as disease duration, disease state, and disease activity come into play. A promising session explored comorbidities in Rheumatoid Arthritis, in particular cancer and cardiovascular events. Here are my takeaways.

Day 2 was a full agenda for those attending EULAR 2025 in Barcelona with sessions on the management of RA, Behcets, Lupus and Hand Osteoarthritis. Clinical overviews on MAS, Ehlers-Danlos, Difficult to treat RA and PsA offered a wide variety of options to rheumatologists. Here are a few interesting presentations from today.

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.