April 2023 to July 2023
Authors: Olivier Fakih and Clementina López-Medina
Annals of the Rheumatic Diseases
TNFi Tapering in RA Patients in Remission
Lillegraven et al (doi: 10.1136/ard-2023-224476) conducted a randomised, open-label, non-inferiority trial enrolling 99 RA patients in remission ≥12 months on stable TNFi therapy. They investigated whether tapering TNFi to withdrawal is non-inferior to stable treatment in preventing disease flares. The primary endpoint was disease flare over 12 months. The results indicated that 63% of patients in the tapering group experienced a flare, as opposed to 5% in the stable group; the non-inferiority margin was exceeded. Both groups had similar DAS remission rates at 12 months after reinitiating full-dose treatment where required.
Role of Sirtuin 6 Deficiency in OA Progression
Collins et al (doi: 10.1136/ard-2023-224385) explored the impact of cartilage-specific Sirt6 deficiency on OA development in male mice. Histological and histomorphometric analyses indicated accelerated OA severity in Sirt6-deficient mice compared to controls. Gene Ontology enrichment revealed repression in extracellular matrix and growth factor activity in human chondrocytes depleted of SIRT6. The study concludes SIRT6 as a critical regulator of IGF-1 signalling in chondrocytes.
Colchicine Prophylaxis and Gout Treatment
Stamp et al (doi: 10.1136/ard-2023-224731) executed a 12-month double-blind, placebo-controlled non-inferiority trial involving 200 gout patients to assess the need for colchicine prophylaxis during allopurinol dose escalation. The primary efficacy outcome was the mean number of gout flares/month for the first 6 months. The study found that non-inferiority was not reached; the colchicine group had fewer flares than the placebo group, but also had more serious adverse events.
Bridging corticoids in RA
Van Ouwerkerk et al (doi: 10.1136/ard-2023-224270) examined the effects of glucocorticoid (GC) bridging in RA patients. Using an individual patient data meta-analysis from three randomized controlled trials, the study found that, apart from the bridging period, GC use was low in both bridgers and non-bridgers. Bridgers showed faster improvement and fewer DMARD changes. GC use was higher in the bridgers at 12 months, and cumulative GC doses differed significantly over 24 months.
Efficacy of Benralizumab in EGPA Patients
Cottu et al (doi: 10.1136/ard-2023-224624) conducted a retrospective study on EGPA patients treated with off-label benralizumab. They found that 49% achieved a complete response, 36% partial, and 15% did not respond. Prior use of mepolizumab was linked to higher rates of failure and less frequent GC discontinuation.
Cellular Variability in Diffuse Cutaneous Systemic Sclerosis
Clark et al (doi: 10.1136/ard-2023-224184) analyzed forearm skin biopsies in dcSSc patients and healthy controls. Single-cell RNA sequencing revealed marked differences in cellular clusters based on disease stage and antibody profile. Overexpression of the TGFβ pathway was seen in anti-topoisomerase positive patients.
Anti-IL-17 Monoclonal Antibody for Inflammatory Diseases
Saviano et al (doi: 10.1136/ard-2023-224479) identified a peptide derived from IL-17A/F that mimics pro-inflammatory actions and developed a novel anti-IL-17 antibody. This new antibody showed fewer off-target effects than secukinumab and exhibited promise in preclinical arthritis models and IBD patient serum samples.
Olivier is a rheumatology resident at the Department of Rheumatology of Besançon University Hospital in France. His research interests include the epidemiology of inflammatory rheumatic diseases, in particular mortality and comorbidities in spondyloarthritis. Olivier is a member of the French Society of Rheumatology and the society’s young rheumatologists section (REF). He is a member of the EMEUNET Social Media sub-committee, in the podcast team.
Clementina López-Medina is a Rheumatologist and postdoctoral researcher at the Spondyloarthritis Unit of the Reina Sofia University Hospital in Cordoba, Spain. Her work focuses on the epidemiology and clinical phenotypes of Spondyloarthritis. Clementina is a member of the Social Media Sub-Committee.