December 2023 to March 2024
Author: Stephanie Ling
Arthritis & Rheumatology
Peripheral blood cellular populations as predictor of RA onset in ACPA+ subjects
Takada et al (doi: 10.1002/art.42839) carried out a study of peripheral blood mononuclear cells (PBMCs) to investigate a potential molecular predisposition to rheumatoid arthritis (RA) in ACPA+ individuals without RA, alongside ACPA+ early RA patients and ACPA- controls without RA. They found that populations of HLA-DR+ Tph cells and CXCR5–CD11c–CD38+ naïve B cells were expanded in ACPA+ participants, which they suggested supported a key role of these cells in transition from pre-RA to established RA. This could represent an important finding in the move towards preventing RA in predisposed individuals in the future.
Risk of venous thromboembolism in tofacitinib-treated Rheumatoid Arthritis
Charles-Shoeman et al (doi: 10.1002/art.42846) used data from the ORAL Surveillance trial to assess VTE incidence over time in patients with RA treated with the JAK inhibitor (JAKi) tofacitinib. The study population consisted of 4,362 patients treated with either tofacitinib 5mg or 10 mg twice daily, or TNFi, with median follow-up of 4 years. Over 72 months, the estimated cumulative probability of VTE with tofacitinib 5 mg bd, tofacitinib 10 mg bd and TNFi, respectively, was 1.4%, 4.5% and 0.8%. This has implications for balancing risk versus benefit of starting JAKis in patients with additional risk factors for VTE.
PLEX does not reduce relapse rate in severe ANCA-associated vasculitis
Junek et al (doi: 10.1002/art.42843) carried out a post hoc analysis on an RCT comparing plasma exchange (PLEX) to glucocorticoid taper in patients with severe ANCA vasculitis, with a view to identifying whether therapy choice impacted on risk of relapse. 704 trial participants were included in the analysis, and 147 (22.7%) experienced 204 relapses, at a rate of 10.3 (95% CI: 8.4 – 12.1) relapses per 100 patient-years. Relapse rate was not affected by use of PLEX or glucocorticoid taper, but PR3 vasculitis and non-haemorrhagic respiratory involvement were associated with increased risk of relapse.
Radiographic progression in secukinumab and adalimumab-treated axial spondyloarthritis
Baraliakos et al (doi: 10.1002/art.42852) present the results of the SURPASS study, the first head-to-head phase IIIb study comparing spinal radiographic progression in 859 patients with radiographic axial spondyloarthritis (AxSpA) treated with secukinumab (150/300mg) or an adalimumab biosimilar. At week 104, the proportions of patients with no radiographic progression were 66.1%, 66.9% and 65.6%, respectively, with no statistically significant differences between the two groups. The safety of both treatments was consistent with previous reports.
Outcomes of autologous stem cell transplantation in an Australian Scleroderma cohort
Gregory et al (doi: 10.1002/art.42850) used previously published RCT data to determine the event-free survival of patients with diffuse cutaneous systemic sclerosis (dcSSc) who met eligibility criteria to receive autologous stem cell transplants (ASCTs), but were eventually managed without. 492 patients were included from the Australian Scleroderma Cohort Study (ASCS), of whom 59 patients met criteria for ASCT, but were not part of ASCT trials. These patients had a similar event-free survival at four years to patients who did receive ASCT, and had improved event-free survival compared to those receiving cyclophosphamide in previous trials. The authors postulated that this might reflect ongoing improvement in standard of care for patients with dcSSc.
Stephanie Ling
Steph is an NIHR Academic Clinical Lecturer at the University of Manchester and a rheumatology trainee in Manchester, UK. Her main research interest concerns treatment response to biologics in patients with rheumatoid arthritis. This is her first year as member of the EMEUNET Newsletter sub-committee.