Day 2 Report from EULAR 2026 Save

Day two at EULAR 2026 was jammed with sessions on advances in immune checkpoint inhhbitors (and irAEs), Lupus, Scleroderma, RA and IgG4 related disease.  Here are a few of my favorites from Day 2. 

• SUNSTAR: Head to head Tocilizumab vs. Abatacept in TNF inhibitor failures (OP0205).  This is one of the few H2H trials that informs us what to do after our first biologic fails.  224 active RA were enrolled after failing 1 TNFi (95%) to receive either subcutaneous TCZ or ABA. (30% each group were on monotherapy; 70% on methotrexate. The primary endpoint was change in CDAI at week 26.  While no superiority for either drug was shown at Week 26; TCZ responses were only better in that TCZ monotherapy was better than ABA monotherapy but equal to ABA plus MTX.  TCZ  had more cytopenias (25 vs 0), dylipidemias (14 vs 7), overall infections (81 vs 50) and serious adverse reactions (13 vs 8) when compared to ABA treated patients.  Most importantly both therapies yielded significant improvement from baseline CDAI scores of ~24 and dropping more than 10 points and DAS28-CRP scores also dropping 40% in both arms.  EULAR 2024 RA guidelines state that we should be switching MOA classes (instead of swapping within class) after failing a b/tsDMARD.  These data support that recommendation.
• RA-ILD Risk Factors and Screening (POS0065). Last year the 2025 ERS/EULAR ILD practice guideline recommended HCRT screening for ILD in rheumatic diseases if ≥2 ILD risk factors are present: 1) Age > 60 yrs, 2) male, 3) Smoding, 4) high disease activity, 5) high seropositivity, and 6) extraarticular manifestations. Hoffmann-Vold et al undertook a post hoc analysis of Swiss Clinical Quality registry (2014–25)  and assessed ILD risk factors in 2456 RA patients and found that 79% had ≥2 risk ILD factors for ILD.  Another presentation on day 1 by Sparks showed that 9% of RA patients, when screened and imaged by HRCT, had ILD.  These studies raise the question of exactly who should be screened with HRCT?  Following the guidelines will lead to overimaging and overexposure to radiation to identify th 10% of RA patients who have ILD.  As early identification is vitally important to early aggressive therapy, we will need more guidance that that supplied by either the ACR or ERS/EULAR guidelines.
• Obexelimab, a new B cell inhibitor for IgG4-related disease (OP018). Interestingly while this was presented today by Della Torre et al, it was also published today in the New England Journal of Medicine.  Obexelimab is a humanized, bifunctional monoclonal antibody that inhibits B cell activation by targeting CD19 and FcγRIIb (CD32b), without causing depletion. It was studied in the INDIGO study - a randomized, double-blind, placebo-controlled trial in 194 active IgG4-RD patients who were treated with glucocorticoids (20–60 mg/day; followed by an 8-week taper to discontinuation. Patients were randomized weekly SC obexelimab (OBE) 250 mg or placebo (PBO) for 52 weeks. The primary endpoint was the time to first IgG4-RD flare requiring  rescue therapy.  bexelimab reduced the risk of flare by 56% versus placebo (HR 0.443; 95% CI 0.277–0.711; p=0.0005). Flares were seen in 27% in the obexelimab group and i55% in the placebo group. Obexelimab showed a significant benefit over placebo with respect to all the key secondary end points, including complete remission (37% vs. 20%, P=0.005) and the cumulative use glucocorticoid rescue therapy (329.5 mg vs. 929.8 mg, P=0.004).. These results suggest both safety and efficacy for OBE in IgG-RD and could become another option in addition to the only FDA approved therapy for IgG4-RD - inebilizumab.