December 2022 to March 2023
Authors: Daliya Pencheva and Cathy Melong
Using data from Swedish Medical Birth Register (MBR), Morin et al (doi.org/10.1016/S2665-9913(23)00001-2) looked into the risks associated with pregnancy and childbirth in women with axial spondyloarthritis (axSpA). Among the 1580 births in women with axSpA, the authors found increased risks of preterm birth (risk ratio 1.43, 95% CI 1.13–1.80), pre-eclampsia (1.44, 1.08–1.92), elective caesarean delivery (1.59, 1.37–1.84), and serious infant infection (1.29, 1.05–1.59) compared with general population comparators, and these risks decreased by around 0.5 percentage points annually, while the use of tumour necrosis factor inhibitors during pregnancy increased.
Mammen et al (doi.org/10.1016/S2665-9913(23)00003-6) reported results from a phase 2 trial of zilucoplan, a complement 5 (C5) inhibitor, a potential therapy in an immune-mediatednecrotising myopathy with positive 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) or signal recognition particle (SRP) autoantibodies. A total of 27 participants were randomly assigned (1:1) to receive daily subcutaneous zilucoplan (0.3 mg/kg) or placebo for 8 weeks. Zilucoplan showed no significant difference in reducing creatine kinase concentrations in immune-mediated necrotising myopathy patients compared to placebo (-15.1% vs -16.3%; p=0.46). The treatment had no unexpected safety or tolerability issues.
Bolhius et al (doi.org/10.1016/S2665-9913(23)00032-2) followed 47 patients (pts) with polymyalgia rheumatica enrolled in the BRIDGE-PMR extension study. One year after the infusion, 9 out of 19 patients (47%) in the rituximab group achieved glucocorticoid-free remission, while 5 out of 22 patients (23%) in the placebo group did the same. The absolute difference between the two groups was 25% (95% CI 4%-53%), with a relative risk (RR) of 2.1 (95% CI 0.8-5.2); however, the result was not statistically significant (p=0.12).
McCarter et al (doi.org/10.1016/S2665-9913(23)00064-4) investigated whether pts with pre-existing rheumatoid arthritis (RA) initiating immune checkpoint inhibitors for cancer might be at risk of increased mortality, RA flares, and immune-related adverse events (AEs). This retrospective study included 11 901 patients (pts) of whom 87 pts with pre-existing RA were matched to 203 non-RA comparators. 60 (69%) pts with RA vs 127 (63%) comparators died (adjusted hazard ratio [HR] of 1.16 [95% CI 0.86–1.57]; p=0.30) and 53 (61%) pts with RA vs 99 (49%) comparators had any immune-related AE (adjusted HR 1.72 [95% CI 1.20–2.47]; p=0.058), showing that pts with pre-existing RA had similar risk of mortality and severe immune-related AEs.
Daliya is a rheumatology resident at the University Hospital “St. Ivan Rilski”, 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.
Cathy Melong is an internist and rheumatologist in final training from Cameroon, currently working in Switzerland. Her main interests are systemic lupus erythematosus and gout, patient-oriented clinical epidemiology. Cathy is a member of the Newsletter Sub-committee.