EULAR 2023 – Day 3 Report Save

Day 3 was a sunny warm day in Milan at the 2023 EULAR Congress meeting. Here are a few of my favorite abstracts from today.

• Rheumatoid Factor Lowering Predicts Improved Outcomes in RA. Abstract OOP0272 presented by Konzett, et al, looked at 1989 RA patients followed over 2 years with usual outcome measures, but they also did serum RF levels every 3 to 6 months. Their analysis sought to examine the clinical consequences of lowering RF levels by >50% (or becoming seronegative); such patients were called “RF Responders”.  They did not examine RF lowering according to drug used, but instead chose to treat RF lowering as a potential desirable outcome, if not a biomarker.  Significant lowering of RF levels (while on DMARD therapy) was seen in 21% at 3 months and 32% at 6 months.  Moreover, RF responders had significantly faster responses, and were more likely to achieve remission or low disease activity state (LDA). The idea that turning a patient to be seronegative is not novel or new as there are studies of patients (infrequently) going from seropositive to seronegative and the favorable clinical outcomes of this status change.  While their findings suggest a value in serial assessment of serum RF; this study needs to be replicated, compared to other biomarkers (CRP, ESR, etc.) and studied to see if it could meet the benchmarks needed to consider this a biomarker worthy of routine use.
• JAKpot Registry Study of MACE Risk.  Abstract OP0219 was a large cohort analysis of RA patients from 15 worldwide registries designed to assess outcomes with JAK inhibitor use.  Their cohort included over 30,000 RA patients who were over age 50 yrs. and had a least once CV risk factor.  This analysis looked for the risk of new, major cardiovascular events (MACE) in RA patients receiving JAK inhibitors compared to patients taking TNF inhibitors or other non-TNF biologics (MOA), with the majority being b/tsDMARDs experienced.  With a mean follow up on therapy of 1.4 years, there was no significant between group difference for MACE events – occurring at a rate of 1.73, 1.94 and 2.55 MACE events per 1000 Patient years (for JAKi, TNFi, MOA, respectively). Unfortunately, this MACE event rate is about 10-fold lower than that reported in the ORAL Surveillance study (~1 event per 100 Pt-Yrs), making for a flawed comparison of JAKpot outcomes to ORAL Surveillance outcomes.  Reasons for MACE event under-reporting were not clear and probably related to combining multinational RA registries operating differently.  Nonetheless, the data accumulated here antedated the Oral Surveillance study reporting, thereby allowing between group comparisons, as any errors in reporting would have been consistent across registries.  There are many reports at EULAR that attempt to recreate the ORAL surveillance data set from large numbers of patients AND they are unified in stating that JAK inhibitors are reasonably equal to TNF inhibitors regarding MACE risk. But none of these post hoc analyses, data reworks or metanalyses can compare to the validity of design and results to their intended comparator – ORAL Surveillance.