EULAR 2020 - Top 5 Abstracts Save

In no particular order, these are my top 5 presentations from this year's EULAR 2020 meeting. Congratulations to EULAR for pulling off the educational coup of the year by transforming their world class gigantic Frankfurt meeting into a worldwide virtual meeting in less than 8 weeks – KUDOS!

1. 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%).   
2. Avacopan as effective as steroids in ANCA Associated Vasculitis (AAV) (OP0011): Dr. Peter Merkel and colleagues presented a 330 patient RCT where AAV was treated with either with rituximab or cyclophosphamide but were randomized to also receive prednisone or avacopan (an oral C5aR antagonist). Week 52 results showed avacopan and prednisone remission rates were same (72% vs 70%) at week 26 and 66% vs 55% at week 52. There was less steroid related toxicity in avacopan treated patients.  https://bit.ly/2Y3zV7g  
3. Tofacitinib – Effective in Systemic Sclerosis (SSc) (FRI0228). Not much seems to ever work in SSc. This pilot trial enrolled 66 SSc patients and randomized them to receive either methotrexate (MTX) 7.5-10 mg/wk or tofacitinib (TOFA) 5 mg bid. Patients were assessed at baseline and week 26 by modified Rodnan skin score (mRSS) and the ultrasound (US) measured skin thickness. Musculoskeletal assessments by ultrasound scored effects on joints and tendons (US10SSc score). At week 26 there was significant reduction in mRSS – a 50% reduction with TOFA vs 8.7% with MTX. This was supported by skin thickness by US with a 12.9% reduction with TOFA vs. 4.7% with MTX.  TOFA was also effective at improving joint and tendon scores by ultrasound (56.2% TOFA vs 12.5% MTX).  This encouraging active controlled trial merits further study with JAK inhibitors in SSc.   
4. Methotrexate does not increase the risk of interstitial lung disease (ILD) by Juge PA, et al (OP0036).  Retrospective, case sontrolled, multinational study compared 482 RA patients with ILD vs. 741 RA without ILD; they found an inverse relationship between MTX exposure and ILD risk (OR 0.41; 95%CI 0.27-0.63).  MTX use also delayed the onset of ILD.  https://bit.ly/2UfN1gL  
5. 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?