[ACR22] Rheumatoid Arthritis II – Clinical (Therapeutic)

Author: Daliya Pencheva

Emery et al (L03) introduced the concept of stimulating human programmed cell death protein 1 (PD-1) as a new rheumatoid arthritis (RA) treatment. In a Phase 2a, placebo-controlled, double-blind, randomized clinical trial peresolimab was superior to placebo for a DAS28-CRP decrease, at week 12, at both tested doses 700 mg (p<0.001) and 300 mg (p=0.017).

Buch et al (L06) evaluated the risk of all adjudicated cardiovascular (CV) events as part of extended major adverse cardiovascular events (MACE) endpoints with tofacitinib versus tumour necrosis factor inhibitors (TNFi) in ORAL Surveillance study. The risk of hospitalization for heart failure (MACE-8) plus venous thromboembolism (VTE) was similar with tofacitinib 5 mg BID vs TNFi (HR 1.12 [0.82,1.52]), but higher with tofacitinib 10 mg BID vs TNFi (HR 1.38 [1.02,1.85]).

Aletaha et al (0272) assessed long-term efficacy of Baricitinib (BARI) 4mg and 2mg in RA patients (pts) who have inadequate response to biologic disease-modifying anti-rheumatic drugs (bDMARD-IR)  for up to 360 weeks (6.9 years) in the completed study RA-BEYOND. SDAI  low-disease activity LDA response rates (RR) were 47%/70% for BARI 4 mg and 61%/74% for BARI 2 mg, at wks 156/360, respectively.

Charles-Schoeman et al (0287) analyzed early predictors of response to treatment with upadacitinib (UPA). Pts who did not demonstrate improvements of ≥6 in CDAI or ≥1.2 in DAS28-CRP within 12 weeks were unlikely to achieve disease activity targets with long-term treatment.

Yokota et al (1435) analyzed the effectiveness of combining tocilizumab (TCZ) with low-dose prednisolone (PSL) compared to TCZ as induction therapy in biologics-naïve pts with active RA. At week 24, a CDAI score of ≤2.8 was achieved by 90.9% of pts in the TCZ plus PSL group compared to 38.5% in the TCZ group (p< 0.05).

Gottenberg et al (1984) compared the incidence of cancer in TNFi and JAKi treated patients based on the French nationwide healthcare database in the RELATION study (n=39,578). In tofacitinib-users, 28 incident malignancy events occurred (IR:5.9 (4.1-8.6) per 1,000 patient-year (PY)) whereas 1,518 occurred in the TNFi group (IR:7.4 (7.0-7.8) per 1,000PY).

van der Pol et al (1987) looked into the association of glucocorticoids usage, level of disease activity and the development of hyperglycemia and diabetes. Disease activity was significantly associated with development of diabetes (HR 1.8, 95% CI 1.3; 2.5).

Alrifai et al (1989) attempted to identify predictors of RA flares after conventional synthetic DMARD (csDMARD) and/or biologic DMARD (bDMARD) tapering within the RHEUMTAP cohort. Patients undergoing any medication taper were 7.6 times more likely to experience a flare (OR 7.68, 95% CI 2.4-24, p=0.0006).

About the Author

Daliya Pencheva


Daliya is a rheumatology resident at the University Hospital “St. Ivan Rilski”, Sofia, Bulgaria. She is also an assistant professor of pathophysiology at the Medical University of Sofia, Bulgaria. Her major interests are systemic lupus erythematosus, quality of life, patient-reported outcome measures,  treat-to-target therapy. Daliya is a member of the Newsletter Sub-Committee.

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