December 2023 to March 2024
Author: Emre Bilgin & Rudi Shukla
Lancet Rheumatology
Saraux et al (doi:10.1016/S2665-9913(23)00246-1) investigated whether abatacept has a role in the management of early polymyalgia rheumatica (PMR). In this proof-of-concept, randomized, double-blind, placebo-controlled, parallel-group trial recent-onset (<6 months) PMR patients without any signs of GCA were assigned to weekly subcutaneous abatacept (125 mg) or matching placebo groups. The primary endpoint was reached by 8 (50%) of 16 patients in the abatacept group and four (22%) of 18 patients in the placebo group (relative risk 2.2 [0.9–5.5]); crude p=0·15; adjusted p=0.070) with leaving an open door for further research.
Ferguson et al (doi:10.1016/S2665-9913(23)00338-7) investigated the relationship between gout and 12 different cardiovascular diseases in the UK Clinical Practice Research Datalink. Of 152 663 individuals with gout and 709 981 matched controls, patients with gout had a higher risk of cardiovascular diseases than matched controls (hazard ratio [HR] 1.58 [95% CI 1.52–1.63]), even after adjusting known cardiovascular risk factors (adjusted HR 1.31 [1.27-1.36]). Excess risk of cardiovascular disease in gout was greater in women than men (women: HR 1.88 [1.75–2.02]; men: HR 1.49 [1.43–1.56]), among all age groups. Patients with gout had higher BMI than matched controls and higher prevalence of chronic kidney disease, dyslipidemia, history of hypertension, obesity, and type 2 diabetes.
Chakravarty et al (doi:10.1016/S2665-9913(23)00320-X) examined the effects of mycophenolate mofetil (MMF) withdrawal on the risk of clinically significant disease reactivation in patients with SLE patients in remission with MMF (MMF duration > 2 years in renal indications, >1 years in non-renal indications). Patients were randomly assigned to a withdrawal group, who tapered off MMF over 12 weeks, or a maintenance group who maintained their baseline dose (1–3g per day) for 60 weeks. The risk of clinically significant disease reactivation was similar between groups (11% (95% CI 5–24) in the maintenance group and 18% (10–32) in the withdrawal group) with similar adverse event profile.
Abhishek et al (doi: 10.1016/S2665-9913(23)00298-9) investigated whether a 2-week interruption of methotrexate immediately after COVID-19 booster vaccination improved antibody response. In this UK-based multicentre, open-label, parallel-group, randomized, superiority trial, adults with immune-mediated inflammatory diseases taking methotrexate at least 3 months were randomly assigned to temporary suspension of methotrexate or continued treatment as usual groups. The distribution of underlying rheumatic diseases was similar (RA was the most common). 383 patients were randomized and at 4 weeks, the geometric mean S1-RBD antibody titer was significantly higher in the suspended methotrexate group than the continued methotrexate group with a geometric mean ratio (GMR) of 2·08 (95% CI: 1·59–2·70; p<0·0001) with a temporary, self-managed increase in the inflammatory disease flare.
Emre Bilgin
Emre is a rheumatologist at Hacettepe University where he is doing his MSc on epidemiology. His main interests are rheumatoid arthritis, adult Still’s disease and ANCA-associated vasculitis, aside from his enthusiasm for editorial activities. Emre is a member of the Social Media Sub-Committee.
Rudi Shukla
Rudi Shukla is a clinical research fellow at the Centre for Musculoskeletal Research, University of Manchester, UK and a rheumatology trainee at Health Education England North West, UK. His research interests include outcome measures in inflammatory arthritis, musculoskeletal ultrasound and omics analyses. Rudi is a member of the Social Media Sub-Committee.