Spring 2024 Press Review – Miscellaneous

December 2023 to March 2024

Author: Ana Rebollo-Giménez

Spring 2024 Press Review – Miscellaneous

Benralizumab not infirerio to Mepolizumab for remission induction in EGPA

Wechsler et al (doi: 10.1056/NEJMoa2311155) conducted a study that involved a phase 3 trial comparing benralizumab to mepolizumab in the treatment of relapsing or refractory eosinophilic granulomatosis with polyangiitis (EGPA). The research included 140 randomized patients, with 70 in each treatment group. The main objective was to assess remission rates at weeks 36 and 48. Results indicated that 59% of patients in the benralizumab group achieved remission compared to 56% in the mepolizumab group at weeks 36 and 48 (difference, 3 percentage points; 95% confidence interval [CI], –13 to 18; P=0.73 for superiority), demonstrating noninferiority but not superiority of benralizumab over mepolizumab for treating EGPA.

Mycophenolate withdrawal in Systemic Lupus Erythematosus

Chakravarty et al (doi: 10.1016/S2665-9913(23)00320-X) evaluated withdrawing mycophenolate mofetil in 100 stable systemic lupus erythematosus (SLE) patients that were randomly assigned to withdrawal or maintenance groups. The primary endpoint was clinically significant disease reactivation by week 60. Results showed an 11% (95% CI 5–24) reactivation rate in the maintenance group and 18% (95% CI 10-32) in the withdrawal group, with a 7% estimated risk increase with withdrawal. Adverse events were similar, but the maintenance group had more infections.  The study suggests mycophenolate mofetil withdrawal is not significantly inferior to maintenance therapy.

Abatacept may reduce the risk of progression of pre-clinical Rheumatoid Arthritis

Rech et al (doi: 10.1016/S0140-6736(23)02650-8) aimed to assess whether 6-month treatment with abatacept improves inflammation in 100 individuals at high risk of developing rheumatoid arthritis (RA) defined by ACPA positivity and subclinical inflammatory changes in hand joints in a double-blind trial. 57% on abatacept showed MRI inflammation improvement compared to 31% on placebo at 6 months. Only 4% on abatacept developed RA versus 17% on placebo. These differences persisted at 18 months post-treatment. Serious adverse events were minimal (8% on abatacept, 14% on placebo). This suggests abatacept may effectively intercept preclinical RA.

CD19 CAR-T cell therapy in connective tissue diseases

Muller et al. (doi: 10.1056/NEJMoa2308917) assessed CD19 chimeric antigen receptor (CAR) T cell therapy in 15 patients with severe SLE, idiopathic inflammatory myositis, or systemic sclerosis. Patients received a single infusion following preconditioning with fludarabine and cyclophosphamide. Results showed that all SLE patients achieved remission, while myositis patients had major clinical responses and sclerosis patients showed decreased disease activity. Immunosuppressive therapy was discontinued in all cases. Adverse events were minimal. These findings suggest CD19 CAR T-cell therapy is safe and effective for various autoimmune diseases, warranting further investigation.

Correlation of salivary gland ultrasound, MRI and salivary function in primary Sjögren Syndrome

Inanc et al (doi: 10.3899/jrheum.2023-0202) aimed to evaluate the validity of the Outcome Measures in Rheumatology (OMERACT) ultrasound (US) semiquantitative scoring system for morphological lesions in major salivary glands by comparing it with magnetic resonance imaging (MRI) and unstimulated whole salivary flow rates (U-WSFRs) in 11 patients with primary Sjögren syndrome. The study found strong agreement between OMERACT US scores and MRI scores for parotid glands (73-91% right, 73-91% left) and moderate agreement for submandibular glands (55-91% right, 55-82% left). There was strong agreement between hyposalivation and a US score of 2 or higher in both parotid glands (91-100%) and moderate agreement in both submandibular glands (55-91%).