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TNF inhibitor

Adherence to TNFi follows different trajectories Cluster 1: “moderate then high” 51% Cluster 2: “moderate then low” 20% Cluster 3: “low adherence, to discontinuation” 18% Cluster 4: “low then high adherence” 11% Most demographic & clinical features CAN NOT predict trajectory!
The incidence of MACEs at 8 years is low in AS patients treated with NSAIDs. Study of 22929 patients, NSAIDs (SHR: 0.40 [0.32-0.49], p<0.001) and anti-TNFs (SHR: 0.61 [0.47-0.81], p<0.001) associated with a lower risk of MACE, Fakih O, Abst#POS0301, #EULAR2023 @RheumNow
What about a new oral drug in active #rheumatoid #arthritis vs #JAKi #Tofacitinib? TLL-018 a potent JAK1/TYK2 inhibitor was compared with #Tofa and dose ranging of 10, 20, 30 mg of TLL-018 and many Pts w past TNFi and w JAKi. High dose won #EULAR2023 @RheumNow @eular_org LB0001

EULAR 2023 – Day 3 Report

Jun 02, 2023

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.

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Tune it at 1pm EST for RheumNow's daily #EULAR23 recaps. You can find us live on Twitter, YouTube and LinkedIn.
JAKi use did not increase CV risk compared to TNF, no difference between Bari and Tofa, non significant increased IRR in patients >65 years, Merel Opdam, Abst#OP0221 #EULAR2023 @RheumNow
Malignancy in real world datasets: do we see differences between DMARDs - particularly JAKi, with ORAL Surveillance in mind? RABBIT German data (limited risk window): Point estimates slightly up vs TNFi, esp in high CV risk pts but magnitude not big OP0218 #EULAR2023 @RheumNow
Just a reminder: nr-axSpA isn’t destined to become r-axSpA/AS. Life is more complicated than that. Between the natural history and TNFi, very small conversion rate post-10y. Of course, whatever the x-rays, it can still disable though DESIR cohort POS0675 #EULAR2023 @RheumNow
TNFi & Disease activity-guided dose optimization in RA⬇️prog of ADA or ETA daily dose (100%66%50%0%) 10yrs followup in 170pts ⭐️74% tapered until full discontinuation ⭐️Median time to restart 8 mo ⭐️21% never restarted! What's lacking? % of recovery @Rheumnow OP0131 #EULAR23
CareRA trial: 3 months addition of LEF vs. ETA in pts resistant to COBRA-Slim regimen (MTX 15 mg/w + step-down prednisone): After 2 years, no difference in dis control but those who received ETA early were treated more frequently w/ csDMARD monotherapy #EULAR23 @RheumNow OP0129
The risk of demyelination with TNFi is low but real. Slight increase of risk was found in male RA patients. The small number of events is reassuring. Careful consideration is recommended in individuals at highest risk of demyelinating diseases Abst#OP0135 #EULAR2023 @RheumNow
#EULAR2023 #OP0142 From #Lupus to #Sjogren. A phase 2 RCT in China showed more patients on Telitacicept (BAFF/APRIL-i) achieved significant reduction in ESSDAI at Wk24 vs PBO. Trend to improvement in glandular function. Intriguing option & will await Phase 3 global RCT @RheumNow
JAKi have superior effectiveness at 6 months compared to TNFi and the efficacy was similar in those with and and without safety risk (increased age, CV risk, smoker) by Hannah Bower, Abst#0133 #EULAR2023 @RheumNow
The overall risk of cancer and cardiovascular disease were decreased in RA treated with JAKi but there was no comparison with TNFi, Sung Soo Ahn, Abst#00132 #EULAR2023 @RheumNow
Biologic dose reduction based on disease activity resulted in 40% reduction in TNFi and did not seem to cause disease deterioration from the 10 year DRESS Study by N van Herwaarden, Abst#OP00131 #EULAR2023 @RheumNow
In insufficient responders, additional Etanercept for 24 weeks (bio-induction) did not show a higher response of DAS28-CRP compared to the standard COBRA-SLIM regime from the CARERA2020 study by Delphine Bertrand, Abstr#00129 #EULAR2023 @RheumNow
Get Un ‘DRESSED’? Use of #etanercept or #adalimumab for #rheumatoidarthritis. #RCT of dose optimization-observational f/u over 10 yrs with attempts to lower and even d/c Rx in #RA You CAN lower dose in many Pts & even d/c Rx and recapture. X-rays OK @RheumNow #EULAR2023 #OP0131
How much MTX do we need with adalimumab in RA? Can blood concentrations help? MTX RBC polygluts: - don’t seem to match to efficacy - do seem match to safety, a bit (no ADAb data here) *One day* we’ll get better at what MTX dose is needed with TNFi #EULAR2023 OP0128 @RheumNow

An update on JAK inhibitors and cardiovascular risks

May 31, 2023

In the last 2 years, there has been more caution and vigilance with the use of JAK inhibitors in the treatment of rheumatoid arthritis due to the risk of CV events, including MACE and VTE. The ORAL surveillance study, a post-approval safety study conducted in RA patients aged ≥50 years with ≥1

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New benefit/risk outlook 👀 on ORAL surveillance 2 subgrps: 🟢RA w/ no previous Hx of atherosclerotic CV dis = TOFA at least as good as TNFi AND risk of MACE is comparable 🛑RA w/ HxASCVD = efficacy TOFA = TNFi AND > risk of MACE OP0043 #EULAR23 @Rheumnow

EULAR 2023: Featured Industry Presentations

May 30, 2023

EULAR 2023 opens tomorrow, Wednesday May 31st, with hundreds of novel presentations and pivotal clinical trials, many being featured industry sponsored clinical trials and research on their novel agents. Below is a collection of the featured abstracts, and presentation times from EULAR 2023

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Save the date! We'll be tuning in live from Milan for EULAR '23. Count on us for: -KOL perspective videos -Clinical Trial Highlights -Daily Faculty Recaps -Live Streaming and more!

3-4-5 Rule (5.26.2023)

May 26, 2023

Dr. Jack Cush reviews more than a dozen news, journal articles and RNL highlights from this past week on

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Prevalence of Psoriatic Arthritis, Spondyloarthritis and Rheumatoid Arthritis in Norway

May 25, 2023

Recent reports have suggested a rising and unrecognized number of patients with psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA) compared to rheumatoid arthritis (RA). This has implications on diagnosis and population care.  A recent analysis of Norway registry data answers this

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Bimekizumab is a dual IL-17A and IL-17F inhibitor, for nr-axSpA and AS - it works but is it different from existing IL-17i? - appears to work well in TNFi-inadequate responders - are TNFi-IR pts immunologically different? #RNL2023