Day 2 – Top 5 from EULAR 2020 Save

These were my top abstracts from Thursday, 4th of June at EULAR 2020.

1. TORTUGA Study (THU0377): Filgotinib in active axial spondyloarthritis patients.  TORTUGA enrolled 116 patients with AxSpA. Previous studies showed improved imaging (SPARCC scores). This study examined 48 patients treated with filgotinib and 39 with placebo who had at Baseline and week 12 MRI. Erosion scores decreased in the filgotinib group and increased in the placebo group (p=0.02).  Backfill scores increased with filgotinib but not placebo (p=0.005) and there was between-group difference in total ankylosis (p=0.46) or fat lesion (p=0.17) changes from baseline. These data showed early changes in SI joint erosion scores with filgotinib therapy.  
2. Tocilizumab in Systemic Sclerosis: long-term open-label safety and efficacy (THU0328).  Tocilizumab (TCZ) has previously been shown to favorably affect lung outcomes in Systemic Sclerosis (SSc), but had variable effects on skin outcomes as judged by mRSS skin scores. This analysis looked at outcomes up to week 96 in all SSc patients taking TCZ. Nearly 85% of SSc patients entered OL therapy and continued TCZ treatment resulted in numeric improvements in mRSS and FVC assessments. No new safety concerns emerged. 
3. EULAR/ERA/EDTA Update on the Management of Lupus Nephritis (OP0163) Evidence based guidelines to inform the treatment of lupus renal disease – intended for rheumatologists, nephrologists, societies and regulators.  There were strong recommendations for hydroxychloroquine (HCQ) in most, mycophenolate (MMF) or the Eurolupus intravenous cyclophosphamide regiment (500mg x6 biweekly doses. Long term treatment with glucocorticoids azathioprine and calcineurin inhibitors was presented. And a role for rituximab was discussed.  Novel was the endpoint objective of achieving UPCR of < 500-700 mg/g by 12 mos. and when kidney biopsy or kidney transplantation should be considered.   
4. BLISS-LN trial (OP0164) – this was a phase 3 trial of belimumab (BEL) in renal biopsy proven class III/IV glomerulonephritis (LN) patients. The primary endpoint was the Primary Efficacy Renal Response (PERR), defined as urine protein creatinine ratio [uPCR] ≤0.7 at week 104. A total of 448 LN patients on background therapies were given either placebo or BEL.  At week 104 there were significantly more PERR responders with BEL (43%) than PBO (32.3%) (OR 1.55, 95% CI 1.04, 2.32; p=0.0311). BEL was also more likely to achieve other secondary endpoints. Adverse events were similar between groups (25.9% vs 29.9%), as were SAE and drug discontinuations (1.8% and 1.3%).  
5. Hydroxychloroquine Levels and Risk of VTE (OP0160) –Dr. Michelle Petri has showed that monitoring HCQ blood levels was an effective means of documenting HCQ compliance in SLE patients. In this study of 812 SLE patients she demonstrated that those patients with low blood HCQ levels were more likely to be at risk for venous thromboembolism (VTE).  VTE occurred in 43 patients.  Lupus anticoagulant was strongly associated with a history of any thrombosis (OR 3.25, p<0.0001). But also those HCQ blood levels were significantly lower in those with VTE. Higher prescribed doses of HCQ also decreased odds of any thrombosis and venous thrombosis (OR 0.88, p=0.04 and OR 0.83, p=0.009, respectively for each 1 mg/kg increase in prescribed HCQ).