Day 4 - Top 3 from EULAR 2020 Save

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

1. Long Delays in Denosumab Increase Fracture Risk (SAT0453).  A UK population based study looked at risk of fracture in adults taking denosumab, based on whether their repeat DEN infusion was on time (24-28 wks. after initial DEN), or if there was a short delay(4-16 wks. late) or long delay (>16 wks. late).  The study showed that long delays (>16 wks.) were associated with a higher rate of vertebral and major osteoporotic fractures; but no hip fractures.  Such data is important in the time of COVID-19 when many therapies have been delayed or put on hold.
2. SELECT CHOICE Study: ABA vs. UPA in bDMARD-IR RA (SAT0151).  A monotherapy trial comparing the safety and efficacy of oral upadacitinib (UPA), head-to-head against abatacept (ABA) IV in 270 RA patients. The primary endpoint was the change in DAS28 (CRP) at Wk 12, which was won by UPA (-2.52 vs -2.00; p <0.001) over ABA. At week 24, UPA was superior to ABA in ACR50, ACR70, and CDAI; but was NOT different with regard to Pain, FACIT, Boolean remission and ACR20 at week 26. Notably, UPA had more serious adverse events (AE) compared to ABA – especially for hepatic disease (23 vs 5 events), grade ¾ lymphopenia (45 vs. 26), opportunistic infection (4 vs. 1), serious AE (10 vs 5), grade ¾ CPK elevation (3 vs 0). There was no difference in the rate of H. zoster or venous thromboembolic events with ABA or UPA.   The question is which is more impressive – the better efficacy of UPA or the better safety of ABA?  
3. FINCH 3 Trial – Filgotinib (FIL) in MTX Naïve RA patients (SAT0158).  A total of 1249 RA MTX naïve patients were randomized to receive FIL 200 mg + MTX, FIL 100 mg + MTX, FIL 200 mg mono or MTX monotherapy.  At week 52, MTX mono was inferior to both doses of FIL +/- MTX in ACR20/50/70 responses and change in Sharp (mTSS) scores. No new safety signals were observed.