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Hi everybody. I'm Katherine Bakewell. I'm reporting to you from Orlando at the ACR conference.
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And what I want to talk to you about is the subject of obesity and GLP-1s and our rheumatic diseases.
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I'm going to give you a little brief overview of today and a little plug for tomorrow.
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We started off with a bang looking at obesity and our rheumatic diseases.
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So to start off, we have the results of TRIUMPH 4.
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Now this was simultaneously published in the New England Journal of Medicine today, November 8th, 2026, at the same time that Philip Cornigan got up — this is from the University of Leeds — and presented Lilly's data.
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So this was again entitled retatrutide once weekly for the treatment of knee osteoarthritis pain and obesity: results from a 68-week phase 3 randomized clinical trial.
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So retatrutide, as you may be familiar, this is an investigational — I should say investigational — triple agonist.
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So this is for GLP-1, GIP, and glucagon.
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In this trial, patients had to have a BMI of at least 27 or higher and knee osteoarthritis.
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They were randomized to receive retatrutide at a dose of either 9 or 12 milligrams versus placebo.
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There was a co-primary endpoint that looked at both the WOMAC score — which you may be familiar with, it's like the numerical rating system or NRS on a scale of 0 to 10, 10 being the worst pain — and the percentage body weight loss at week 68. There were 445 patients randomized.
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This was a very positive trial. So the change from baseline in the WOMAC was minus 4.4 in roughly both of the treatment groups versus 2.4 with placebo.
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But remember that even the placebo-treated patients were encouraged to exercise up to 150 minutes weekly.
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And the change from baseline in body weight percentage was 26% in the retatrutide 9 mg and 28.7% in the retatrutide 12 milligram subcutaneous once weekly group versus about 2% in placebo.
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Roughly a third of your body weight — rivals what we see with bariatric surgery.
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So we now have an investigational weight loss agent that produces very significant and profound body weight loss, and we see that it also significantly reduces pain from knee osteoarthritis.
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They do have X-rays in the trial. There was a signal but we're waiting to see what comes from that.
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My take-home is that roughly 70% of patients saw a 70% improvement in the WOMAC pain scale.
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I like the 70/70 because it's easy to remember.
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There was a 40% reduction in triglycerides and about a 50% reduction in the hsCRP.
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More to come on that — we hope to see that approved sometime middle of next year, maybe for obesity first, and then end of next year later would be for knee osteoarthritis.
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So pardon me — obesity first, knee osteoarthritis second.
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The next thing I want to highlight is a presentation from Vineeta Ranath that happened from 11 to 11:30 today.
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It was entitled GLP-1 receptor agonists: perspectives on use in autoimmune inflammatory rheumatic diseases.
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She covered everything from the basic science to the impact of obesity on patients with rheumatoid arthritis, psoriatic arthritis, spondyloarthritis, and that it not only is a risk factor for disease but portends worse disease activity.
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These patients are less likely to respond to therapies than their counterparts who are not living with obesity.
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Some of the key pivotal trials that she covered in the talk were the results from the TOGETHER PSO and PSA trials.
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And this was the combination of ixekizumab in either patients with psoriasis or psoriatic arthritis with tirzepatide.
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There was a combined or co-primary endpoint looking at either the ACR50 plus a 10% body weight loss for the TOGETHER PSA trial, or the PASI 100 and the 10% body weight loss for TOGETHER PSO.
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Both of these were positive trials. Most interestingly for us in rheumatology, if you look at just the ACR50 results, you see that 20% of
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patients treated with ixekizumab alone hit the ACR50 versus 33% when you had added in tirzepatide — raising the question for us in rheumatology: is
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this truly a DMARD therapy? More to come on that.
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We also had presented today an abstract — this is going to be number 0361 — GLP-1 receptor agonist eligibility and uptake and its relation with psoriatic arthritis disease activity and cardiovascular morbidity: real-world data from a cardiorheumatology cohort.
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So this was Lihi Eder's group out of the University of Toronto.
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They have what they call a cardiorheumatology clinic and they asked the question: out of eligible patients over the age of 40 — they had 834 patients, 284 with PsA, 482 with RA, and 72 with axial SpA — who would be eligible for a GLP-1 receptor agonist therapy.
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This was determined by a BMI of at least 27 with cardiovascular morbidities, or a BMI over 30, or diabetes mellitus.
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They determined that almost half of the patients in their clinic were candidates for GLP-1 therapy, but only about 10% of the patients in the clinic were on GLP-1 receptor therapy.
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Again, this is a different country — there are issues of access.
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But I'm going to contrast that to the last thing I'm going to leave you with.
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So this is abstract 1304. This is coming tomorrow, November 9th, 10:30 to 12:30, here presented in the poster hall.
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This poster has a lot of names you're familiar with — Dafna Gladman, Ian McInnes, Alice Gottlieb, to name just a few — but it's
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entitled bimekizumab and glucagon-like peptide-1 receptor agonist concomitant use in patients with psoriatic arthritis and axial spondyloarthritis: a cross-sectional analysis of US claims data.
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So they looked at the Komodo Health US database and they found 11,000 patients with psoriatic arthritis treated with bimekizumab and 4,000 patients with axial spondyloarthritis treated with bimekizumab.
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They found that across both cohorts about 21% of patients were receiving GLP-1 receptor agonist therapy, and that the number was growing over time.
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So I think what we're going to find is that the number varies depending upon which country you live in, and that the number is growing as more and more people adopt the use of this therapy — not only in our rheumatic diseases but hopefully in 2027 for osteoarthritis as well.
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And with that I will leave you. Thank you.
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