EULAR 2024 - Day 1 Report Save

Wednesday was Day One at EULAR 2024 in Vienna. While the day was a slow start, the poster halls and auditoriums quickly filled with thousands of rheumatologists, eager to reunite at this international educational forum. Below are a few of my favorites from Day 1. 

SLE Skin Responses to Tyk2 Inhibitor

• The results of the PAISLEY trial were published in Nov. 2022 – this was a phase 2 trial that demonstrated the efficacy and safety of deucravacitinib, an oral, TYK2 inhibitor, in adults with active systemic lupus erythematosus (SLE). A total of 363 patients were randomized to receive either deucravacitinib 3 mg twice daily, 6 mg twice daily, 12 mg once daily, or placebo.  At week 32, an SRI-4 response of 34% was seen with placebo compared to 58% with deucravacitinib 3 mg twice daily (P < 0.001).  The new study (OP0048) is a subanalysis of the PAISLEY study looking at the cutaneous responses in 101 chronic LE patients treated with DEUC with outcomes assessed by the CLASI (cutaneous lupus disease area and severity index; either at the 50% (CLASI-50) and 70% (CLASI-70) level. At 48 weeks the CLASI-50 responses were 16.7%, 69.6%, 56%, and 62.1% for those treated with placebo or DEUC 3 mg bid, 6 mg bid, and 12 mg qd, respectively. The CLASI-70 also showed superiority and was sustained for DEUC 3 mg bid vs. placebo (65.2 vs. 8.3%. Similarly superior skin responses were seen in subtypes of CLE – acute LE, discoid LE, subacute LE and chronic CLE.  Two large, phase 3 trials are in progress and will assess the efficacy and safety of deucravacitinib in SLE patients.

Dental Loss and RA Risk:

• Researchers from Leiden studied 700 patients with clinically suspect arthralgias (CSA), finding 96 who were ACPA+ (13.7%) and 121 (16%) who developed inflammatory arthritis (IA). They assumed that tooth extraction to be a surrogate for periodontal disease and found dental extraction in 206 patients (who were older, smokers with higher BMI and more subclinical joint inflammation).  Ultimately, tooth extraction was significantly associated with IA development, but only in ACPA+ patients (HR=1.91; p=0.001). These findings were independent of socioeconomic status or inflammation on MRI. (POS0467)

Does Biologic Use in Psoriasis Reduce Risk of Psoriatic Arthritis?

• There have been several conflicting studies about the potential protective effect of biologics in psoriasis (PSO).  This abstract (OP0010) was a retrospective claims study of over 213 million persons, from whom 1.75 million PSO patients and 246,900 PsA patients were identified. 928,100 PSO patients without PsA were analyzed for the impact of their first biologic therapy (Inhibitors of TNF, IL-17, IL-12/23, and IL-23) and looked at the future development of PSA with 5 years of follow up.  Compared to those treated with TNFi, PSO patients treated with an IL-12/23 or IL-23 inhibitor had a 34% and 60% lower risk of developing PsA (). The IL-23 inhibitors also significantly lowered the risk of future PsA (at 3 yrs and 5 yrs) compared to those treated with IL-17 inhibitors. While inhibitors of IL-12/23 and IL-23 were superior to TNFi and IL-17 agents in preventing future PsA is not entirely clear. Yet IL-23 targeting has been shown to be superior to the other agents in treating Psoriasis.