The EULAR 2015 Report - Wednesday Save

EULAR 2015 started the afternoon of Wednesday June 10th.

In addition to several overview sessions (psoriatic arthritis, osteoporosis, autoinflammatory disease), EULAR presented its guidelines for 1) Cardiovascular diseases in RA, 2) Management of Comorbidity, and 3) Management of Psoriatic Arthritis.Later in the week, EULAR guidelines on Systemic Sclerosis will be presented.

A late Wednesday session was devoted to Pregnancy and Rheumatic diseases.Dr. A. Strangfeld reported on the German RABBIT registry that has 9373 RA women, of whom 1981 are of child-bearing potential (#OOP0017). Theiranalysis of 64 pregnancies from 42 women revealed that biologic exposure during preconception or 1st trimester did not affect live births (~80%) or adverse pregnancy outcomes.They showed biologic exposure before or at conception did not influence the maternal course of RA activity. Importantly, 23% were in remission before pregnancy, but only 43% stayed in remission during the pregnancy. Hence, their experience argues against the old adage that pregnancy induces remission in RA.

On behalf of Dr. Megan Clowse and co-authors, I presented the latest data on certolizumab (CZP) exposure during pregnancy (#OP0018).This database of 625 cases on file at UCB is one of the largest single drug pregnancy exposure cohorts ever reported with a biologic. Known outcomes were limited to 372 pregnancies.Ten percent of these were from paternal exposures – whose outcomes matched that seen with maternal exposure. Of the maternal exposures, 226/339 were prospectively followed; 1/3 had inflammatory arthritis and 2/3 had Crohn’s disease.Live births were seen in 80.5%, miscarriages in 9.3% and 4.4% had a congenital anomaly.There was no pattern of organ involvement seen in the 8 prospective and 4 retrospective anomalies reported. CZP lacks an Fc portion and should thereby not be transferred to the fetus when used.This data and the construct should be a potential advantage for women who wish to become pregnant or require treatment during pregnancy.

In the days to come (Thursday through Saturday), there will be thousands of posters and presentations. Here is a compilation of some I am looking forward to seeing:

• Numerous studies will be presented examining the success of treatment de-escalation (spacing) or biologic/DMARD discontinuation in RA patients who have achieved low activity or remission.These studies are mostly open-label or retrospective, but nonetheless follow on the heels of the OPTIMA, PRECISION, PRIZE and other “step-down” protocols. At issue is whether these data will change the rheumatologists' thoughts on adherence to combo therapy versus being more permissive in those who wish to take fewer drugs.
• C- Early is a study of CZP in early RA. It is the only remaining TNFi to not yet be studied in an early RA population. The question is whether CZP can differentiate itself from other TNFi with regard to efficacy, magnitude of effect, safety events or other important outcomes (e.g., radiographic outcomes).
• New psoriatic drugs will continue to be examined for efficacy, but also for safety. The extended or 2-year safety data will be presented for apremilast, secukinumab and ustekinumab.
• Report examines why smoking and methylation interactions may also increase risk in ankylosing spondylitis.
• There is an analysis that will show that fibromyalgia patients do not meet criteria for spondyloarthritis.
• There is an adage that says if you ever had a serious infectious event (SIE) you're likely to get it again and be at risk of dying from it the second time around.Abstract OP0161 examines patients with a history of sepsis or SIE and shows that continued use of a TNF inhibitor (and other biologics) was surprisingly associated with a lower risk of SIE recurrence.
• A Canadian cohort analysis will show that DMARD use in the first year will decrease the need for future joint surgery.
• Several studies will claim that (like rituximab) seropositivity for RF/CCP is associated with a higher response rate to abatacept or tocilizumab therapy.
• New drugs for lupus and lupus subpopulation studies will be presented.
• Orally administered Leisinurad (URAT-1 inhibitor) has three clinical trials showing its ability to significantly reduce serum uric acid levels, but must be used with another urate-lowering therapy. The utility and safety need to be reviewed.