EULAR 2024 – Day 4 Report Save

The final day of EULAR 2024 was rich in posters, Late-breaking oral presentations and EULAR updates and recommendations.  Below is a synopsis of the half-day's action.

JAK inhibitor Treatment of Giant Cell Arteritis (GCA)

• A late-breaking abstract (LBA0001) reported on the efficacy of upadacitinib (UPA) when tested against placebo in a double blind randomized controlled phase 3 trial in 428 adult (> 50yrs) GCA patients. The primary endpoint was sustained remission of GCA from week 12 through week 52 and adherence to the protocol-defined steroid taper regimen. The results of the 52-week trial showed superiority of UPA15 vs PBO (46% vs 29%, P=.0019).  UPA15 resulted in a decreased risk for flare through 52 wks., compared to PBO.   

BSRBR Review of EMA JAK inhibitor Warnings

• The British Society for Rheumatology Biologics Registry studied (POS0390) their RA patients starting JAK inhibitor therapy (n=1372) prior to May 2022 to assess the effect of the European Medicines Agency warnings on JAKi use; notably cautioning against JAKi use in patients ≥65 years, with CVD risk factors, current or past smokers or prior cancer.  Surprisingly 80% had at least 1 EMA at-risk criteria; and 59% had 2 or more. In this cohort 28% had received 3 or more classes of bDMARDs. Their suggestion was that most RA patients were at high-risk for JAK safety concerns and that other agents should be considered first.  These findings are much higher than other cohort reviews and my own clinic patient experience. Nonetheless, rheumatologists are still concerned about the regulatory cautions emanating from the Oral Surveillance reports in 2021. 

Stop or Continue Biologics with Infection?

• A Dutch open-label randomized trial of 1142 RA, PsA and SpA (POS0891) patients taking immunomodulatory agents (45% bDMARDs, 9% tsDMARDs) who were randomized to either continue therapy or suspend therapy with clinically relevant infections (n=475).  There were few subsequent serious infections with no significant difference between the continuation group (3.7%) and interruption group (5.1%).  The data suggests that temporary suspension of csDMARDs, bDMARDs or tsDMARDs with infection is NOT warranted in patients with chronic inflammation.