What Is New - Rheumatoid Arthritis
Take a look at our 'What is new' highlights in rheumatoid arthritis!
May 2023
"A Phase 2 Trial of Peresolimab for Adults with Rheumatoid Arthritis"
Why WIN?
After the JAKi revolution, a new bDMARD showed efficacy in rheumatoid arthritis (RA). Peresolimab is a monoclonal antibody that stimulate PD-1 inhibitory pathway (unlike the PD-1 inhibitors used as immune checkpoint inhibitors in several cancers). This Phase 2, randomized, placebo-controlled trial included 98 patients with RA with inadequate response, loss of response or unacceptable side effects with csDMARDs or b/tsDMARDs. They were randomized to receive 700mg or 300mg of peresolimab or placebo (1 I.V. Infusion every 4 weeks). At week 12, the primary outcome (change in DAS28-CRP from baseline) was met for both 700mg and 300mg groups compared to placebo. A difference in ACR20 response was only observed for the 700mg group. No difference could be identified for ACR50 and ACR70 response. No safety warning were reported. Longer/larger trials are pending
Because of the mechanism of action of peresolimab (stimulation of PD-1 inhibitory pathway), would you be afraid for malignancies?
Yes / No
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Link to original article: https://www.nejm.org/doi/10.1056/NEJMoa2209856?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
April 2023
"Reduced versus maximum tolerated methotrexate dose concomitant with adalimumab in patients with rheumatoid arthritis (MIRACLE): a randomised, open-label, non-inferiority trial"
Why WIN?
In rheumatoid arthritis (RA), continuation of methotrexate (MTX) whith biologic DMARDs is recommended but optimal dose of MTX is unclear. In this randomized control trial from Japan, Korea and Taiwan, patients with RA with inadequate response to MTX were randomly assigned to adalimumab (ADA) with reduced dose of MTX or full dose MTX. After 24 week, no difference was observed in term of proportion of patients acheiving remission. Adverse events such as hepatotoxicity were more frequent in the full dose MTX arm.
This study suggests that, in RA, MTX dose can be reduced by nearly 50% at the time of TNF inhibitor initiation.
In RA, when initiating a TNF inhibitor in inadequate answer to MTX, would you rather keep a full dose or a reduced dose of MTX?
Yes / No
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March 2023
" Reducing cardiovascular risk with immunomodulators: a randomized active comparator trial among patients with rheumatoid arthritis"
Why WINS?
Rheumatoid arthritis (RA) is associated with an increased risk of cardiovascular (CV) diseases, partly due to the link between inflammation and athero-sclerotic diseases. In RA, non-randomized studies demonstrated a potential impact of TNF inhibitors on CV events. This is the first randomized trial assessing the reduction in arterial inflammation when adding a TNF inhibitor compared to sulfasalazine + hydroxychloroquine in patients with active RA despite methotrexate. A similar reduction in arterial inflammation, assessed with 18FDG PET CT scans, was observed in both groups with no association with disease activity.
Do you think biologic DMARDs are more effective than conventional DMARDs to reduce CV events in RA?
yes / no
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February 2023
" Incidence of dementia in patients with rheumatoid arthritis and association with disease-modifying anti-rheumatic drugs: Analysis of a national claims database."
Why WINS?
Few studies have reported, with mixed results, on the association of RA and incident dementia. This large observational study represents a feasible approach to better understanding the role of DMARDs in comorbidities associated to RA.
In patients with RA, the risk of dementia may change depending on the type of background DMARD treatment.
Agree / DIsagree
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Jan 2023
"Treatment outcomes for rheumatoid arthritis associated interstitial lung disease; a real-world, multisite study of the impact of immunosuppression on pulmonary function trajectory"
Why WINS?
There are no randomized, placebo-controlled data to support the role of immunosuppression to treat RA-ILD despite being widely used in clinical practice.
Immunosuppression improves pulmonary function in patients with RA-ILD.
Agree or disagree?
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December 2022
" Intervention with methotrexate in patients with arthralgia at risk of rheumatoid arthritis to reduce the development of persistent arthritis and its disease burden (TREAT EARLIER): a randomised, double-blind, placebo-controlled, proof-of-concept trial "
Why WINS?
This study is the first to evaluate the efficacy of MTX when initiated in the pre-arthritis phase. It shows that a temporary treatment, started in the arthralgia and subclinical joint inflammation stage, did not prevent clinical arthritis but resulted in sustained disease modification.
Interactive question
Do you consider initiating treatment with MTX in patients with arthralgia clinically suspected of progressing to RA?
yes / no
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November 2022
" Age-associated B cells contribute to the pathogenesis of rheumatoid arthritis by inducing activation of fibroblast-like synoviocytes via TNF-α-mediated ERK1/2 and JAK-STAT1 pathways "
Why WINS?
This is the first demonstration that age-associated B cells display peculiar transcriptomic properties that may impact their ability to migrate into the inflammatory joints inducing fibroblast-like synoviocytes activation.Interactive question.
Interactive question
Have you ever heard about the potential role of this B cell subpopulation in autoimmune diseases?
yes / no
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"Demographic, Lifestyle, and Serologic Risk Factors for Rheumatoid Arthritis (RA)–associated Bronchiectasis: Role of RA-related Autoantibodies"
Why WINS?
This study expands the list of potential risk factors for bronchiectasis in RA and emphasize the important and complex interactions between airway inflammation and RA.
Interactive question
RA-associated bronchiectasis (RA-BR) is associated with increased morbidity and mortality compared to patients with RA who do not have bronchiectasis.
Agree / Disagree
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October 2022
"Standardisation of ACPA tests: evaluation of a new candidate reference preparation"
Why WINS?
ACPA titer has a high impact on RA classification. This study proposed a new candidate of ACPA standard that improved the alignment of most ACPA assay.
Interactive question
Do you pay enough attention to lab assays when you evaluate your patient’s lab results?
yes / no
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"Effectiveness of TNF-inhibitors, abatacept, IL6- inhibitors and JAK-inhibitors in 31 846 patients with rheumatoid arthritis in 19 registers from the ‘JAKpot’ collaboration"
Why WINS?
This large comparative effectiveness analysis, involving 19 registers and over 30 000 treatment courses, is the first to evaluate real life effectiveness and safety outcomes among four common available treatment alternatives in RA.
Interactive question
After an inadequate response to a first JAK inhibitor, Do you consider Cycling or Switching?
yes / no
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September 2022
"Loss of balance between protective and pro-inflammatory synovial tissue T-cell polyfunctionality predates clinical onset of rheumatoid arthritis"
Why WINS?
A pathogenic T-cell phenotype was found at synovial level in individuals at risk for rheumatoid arthritis in a pre-clinical phase.
Interactive question
Had you ever heard about the potential central role of CD4+CD8+ in early rheumatoid arthritis?
yes / no
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"Patient-Reported Nausea and Fatigue Related to Methotrexate: A Prospective, Self-Controlled Study in the ArthritisPower Registry"
Why WINS?
This is a self-controlled case series study using electronic patient-reported outcome measures (e-PROMs) to generate real-world evidence regarding patients' experiences and perceptions of MTX side effects, especially in RA.
Interactive question
Do you use any digital tool to assess Methotrexate side effects/adherence in patients with Rheumatoid Arthritis?
yes / no
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May 2022
"The Impact of Disease Severity Measures on Survival in US Veterans with Rheumatoid Arthritis-Associated Interstitial Lung Disease"
Why WINS?
This is the first study to clearly identify an impact of rheumatoid arthritis (RA) disease activity on survival in patients with RA associated intersitital lung disease (ILD) . These results suggest that RA remission should be achieved in patients with RA-ILD
Interactive question
DMARDs in RA-ILD: prevent potential lung toxicity versus RA remission. Should RA disease activity be controlled at any cost in patients with RA-ILD?
Agree / Disagree
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"Extramucosal Formation and Prognostic Value of Secretory Antibodies in Rheumatoid Arthritis"
Why WINS?
This is the first study to show that secretory Ig are elevated in the circulation prior to RA onset, supporting possible extramucosal formation of secretory component-containing ACPAs.
Interactive question
Do you agree that rheumatoid arthritis may be triggered by extramucosal production of anti-citrullinated protein antibodies in the pre-clinical phase?
Agree / Disagree
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April 2022
"Humoral and cellular immune responses to two and three doses of SARS-CoV-2 vaccines in rituximab-treated patients with rheumatoid arthritis: a prospective, cohort study" by Jyssum et al.
Why WIN?
- Current literature suggests that treatment with rituximab puts patients at an increased risk of COVID-19-related hospitalization and death, even after vaccination.
- Jyssum and colleagues show that a third COVID-19 cavvination does not substantially improve humoral protection.
- Considering these findings, it is advisable to discuss alternatives for rituximab therapy with patients.
Interactive question
Rheumatologist should not initiate rituximab treatment for RA patients at this time...
Agree / Disagree
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March 2022
February 2022
December 2021
November 2021
October 2021
Jan 2021
December 2020
November 2020
October 2020
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December 2019
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