EULAR 2017 – Day 4 Highlights Save

Saturday was a day of big posters and special seminars at EULAR in Madrid.  In the morning, I passed on an interesting session on nailfold capillaroscopy led by Dr. M Cutolo and went to a JIA outcomes session. I reported on this in a video from day 4 (Saturday) called “Long-Term Comorbidities in JIA” – you can find it here. There were plenty of posters of interest, including presentations on: 

• JAK inhibition and pain? Baricitinib was studied in RA patients in the BEAM and BEACON trials. A post hoc analysis showed that pain improvement (>30% by VAS) was superior to placebo (PBO) at week 1 and was significantly better than adalimumab by week 3 in the BEAM trials. In the RA-BEACON trial baricitinib 4 mg was better than the 2 mg dose at pain improvement ≥30% also as early as Week 4. These pain findings were sustained for 24 weeks in both trials. The caveat here being does the rapid onset of effect w/ JAK inhibition offer a potential advantage over TNF inhibitors in modulating pain in RA patients.  (SAT 0055)
• Tofacitinib Monotherapy or Not: The ORAL-STRATEGY study was presented at this meeting and tested 1146 MTX-IR patients, putting them on either tofacitinib (Tofa) monotherapy or added Tofa or adalimumab to a background of MTX. This study answers the question whether you continue MTX or stop it if transitioning to Tofa. The results showed that either combination (Tofa + MTX; or ADA + MTX) was superior to Tofa monotherapy. However, the primary endpoint was noninferiority of all therapies and since the Tofa monotherapy group did not meet the noninferiority criteria, the results are inconclusive. The interpretations of this are multiple and even confusing. My take is that they did not show Tofa monotherapy equivalence to the Tofa + MTX regimen and thus when I make the move to Tofa, I’ll be continuing the background MTX therapy.  What rheumatologist doesn’t favor combo therapy that includes MTX? (LB0003)
• Hope for Erosive Hand OA – ABT-981 is an anti-IL1 alpha and beta monoclonal antibody that was studied in 131 erosive hand OA (HOA) patients against placebo for 6 months. Although this mAb decreased CRP, neutrophils and IL-1 levels, there was no difference compared with placebo for this novel therapy. The search for effective therapy in erosive, inflammatory hand osteoarthritis continues. (OP0168)
• IV Golimumab in PsA: a 6 mos. DBRPCT studied the effect of golimumab (GOL) in biologic-naïve active psoriatic arthritis (PsA).  Patients were treated with either PBO or IV GOL 2 mg/kg at Weeks 0, 4, and every 8 weeks. At the primary endpoint week 14, there were impressive ACR20, 50, 70 responses 75%, 44% and 25% and the PASI75 response in 59%.  These results were quite encouraging amidst a field of many new and variably effective therapies for PsA at EULAR 2017. (FRI0486)