Rheumatoid Arthritis

Key clinical point: Janus kinase inhibitors (JAKi) were more potent in inhibiting bone mineral density (BMD) loss compared with other targeted therapies in patients with rheumatoid arthritis (RA), specifically in those with anti-cyclic citrullinated peptide antibody (ACPA)-positive RA.

Major finding: JAKi therapy led to greater gains in bilateral femoral BMD than conventional synthetic disease-modifying antirheumatic drugs (csDMARD; P < .05), tumor necrosis factor inhibitors (TNFi), and non-TNFi biologics, with the improvements in femoral BMD being significant in patients with ACPA-positive RA (P < .01) but not in those with ACPA-negative RA. Similar trends were observed for BMD values at the lumbar spine.

Study details: This retrospective observational study included 362 patients with RA who were treated with JAKi, csDMARD, TNFi, and non-TNFi biologics.

Disclosures: This study was supported by the National Science and Technology Council, Taiwan, and other sources. The authors declared no conflicts of interest.

Source: Chen YW et al. Potential alleviation of bone mineral density loss with Janus kinase inhibitors in rheumatoid arthritis. Clin Rheumatol. 2023 (Sep 2). doi: 10.1007/s10067-023-06735-0

Key clinical point: Janus kinase inhibitors (JAKi) were more potent in inhibiting bone mineral density (BMD) loss compared with other targeted therapies in patients with rheumatoid arthritis (RA), specifically in those with anti-cyclic citrullinated peptide antibody (ACPA)-positive RA.

Major finding: JAKi therapy led to greater gains in bilateral femoral BMD than conventional synthetic disease-modifying antirheumatic drugs (csDMARD; P < .05), tumor necrosis factor inhibitors (TNFi), and non-TNFi biologics, with the improvements in femoral BMD being significant in patients with ACPA-positive RA (P < .01) but not in those with ACPA-negative RA. Similar trends were observed for BMD values at the lumbar spine.

Study details: This retrospective observational study included 362 patients with RA who were treated with JAKi, csDMARD, TNFi, and non-TNFi biologics.

Disclosures: This study was supported by the National Science and Technology Council, Taiwan, and other sources. The authors declared no conflicts of interest.

Source: Chen YW et al. Potential alleviation of bone mineral density loss with Janus kinase inhibitors in rheumatoid arthritis. Clin Rheumatol. 2023 (Sep 2). doi: 10.1007/s10067-023-06735-0

Key clinical point: Janus kinase inhibitors (JAKi) were more potent in inhibiting bone mineral density (BMD) loss compared with other targeted therapies in patients with rheumatoid arthritis (RA), specifically in those with anti-cyclic citrullinated peptide antibody (ACPA)-positive RA.

Major finding: JAKi therapy led to greater gains in bilateral femoral BMD than conventional synthetic disease-modifying antirheumatic drugs (csDMARD; P < .05), tumor necrosis factor inhibitors (TNFi), and non-TNFi biologics, with the improvements in femoral BMD being significant in patients with ACPA-positive RA (P < .01) but not in those with ACPA-negative RA. Similar trends were observed for BMD values at the lumbar spine.

Study details: This retrospective observational study included 362 patients with RA who were treated with JAKi, csDMARD, TNFi, and non-TNFi biologics.

Disclosures: This study was supported by the National Science and Technology Council, Taiwan, and other sources. The authors declared no conflicts of interest.

Source: Chen YW et al. Potential alleviation of bone mineral density loss with Janus kinase inhibitors in rheumatoid arthritis. Clin Rheumatol. 2023 (Sep 2). doi: 10.1007/s10067-023-06735-0

Key clinical point: Circulating semaphorin 4A (SEMA4A) serum levels predicted treatment failure and showed an association with response to therapy in patients with rheumatoid arthritis (RA).

Major finding: Baseline serum levels of SEMA4A > 94 ng/mL predicted the risk for treatment failure defined by the occurrence of flares and treatment escalation (adjusted hazard ratio [aHR] 2.73; 95% CI 1.24-5.96). The baseline SEMA4A serum levels were significantly higher in patients who experienced no or moderate response than in those with a good response (P = .035).

Study details: The data come from a prospective observational routine care study that included two cohorts; the first cohort comprised 101 patients with established RA and the second comprised 40 patients with RA who initiated new therapy due to insufficient disease control.

Disclosures: E Vandebeuque declared receiving grants from the Société Française de Rhumatologie, Paris, and other sources. The authors declared no conflicts of interest.

Source: Avouac J et al. Relevance of circulating Semaphorin 4A for rheumatoid arthritis response to treatment. Sci Rep. 2023;13:14626 (Sep 5). doi: 10.1038/s41598-023-41943-3

Key clinical point: Circulating semaphorin 4A (SEMA4A) serum levels predicted treatment failure and showed an association with response to therapy in patients with rheumatoid arthritis (RA).

Major finding: Baseline serum levels of SEMA4A > 94 ng/mL predicted the risk for treatment failure defined by the occurrence of flares and treatment escalation (adjusted hazard ratio [aHR] 2.73; 95% CI 1.24-5.96). The baseline SEMA4A serum levels were significantly higher in patients who experienced no or moderate response than in those with a good response (P = .035).

Study details: The data come from a prospective observational routine care study that included two cohorts; the first cohort comprised 101 patients with established RA and the second comprised 40 patients with RA who initiated new therapy due to insufficient disease control.

Disclosures: E Vandebeuque declared receiving grants from the Société Française de Rhumatologie, Paris, and other sources. The authors declared no conflicts of interest.

Source: Avouac J et al. Relevance of circulating Semaphorin 4A for rheumatoid arthritis response to treatment. Sci Rep. 2023;13:14626 (Sep 5). doi: 10.1038/s41598-023-41943-3

Key clinical point: Circulating semaphorin 4A (SEMA4A) serum levels predicted treatment failure and showed an association with response to therapy in patients with rheumatoid arthritis (RA).

Major finding: Baseline serum levels of SEMA4A > 94 ng/mL predicted the risk for treatment failure defined by the occurrence of flares and treatment escalation (adjusted hazard ratio [aHR] 2.73; 95% CI 1.24-5.96). The baseline SEMA4A serum levels were significantly higher in patients who experienced no or moderate response than in those with a good response (P = .035).

Study details: The data come from a prospective observational routine care study that included two cohorts; the first cohort comprised 101 patients with established RA and the second comprised 40 patients with RA who initiated new therapy due to insufficient disease control.

Disclosures: E Vandebeuque declared receiving grants from the Société Française de Rhumatologie, Paris, and other sources. The authors declared no conflicts of interest.

Source: Avouac J et al. Relevance of circulating Semaphorin 4A for rheumatoid arthritis response to treatment. Sci Rep. 2023;13:14626 (Sep 5). doi: 10.1038/s41598-023-41943-3

Key clinical point: Tofacitinib combined with iguratimod relieves clinical symptoms and results in a higher response rate compared with conventional synthetic disease-modifying antirheumatic drugs (csDMARD) in patients with rheumatoid arthritis with usual interstitial pneumonia (RA-UIP).

Major finding: After 6 months, treatment with tofacitinib + iguratimod vs csDMARD significantly improved forced vital capacity percentage (P = .031) and high-resolution computed tomography fibrosis score (P = .015) and resulted in a higher overall response rate (66.7% vs 35.7%; P = .027), with no patients discontinuing tofacitinib or iguratimod due to side effects or poor efficacy.

Study details:This prospective observational cohort study included 78 patients with RA-UIP who received tofacitinib + iguratimod, csDMARD + iguratimod, or csDMARD.

Disclosures: This study did not declare any specific funding source. The authors declared no conflicts of interest.

Source: Wang S et al. A prospective observational cohort study of the efficacy of tofacitinib plus iguratimod on rheumatoid arthritis with usual interstitial pneumonia. Front Immunol. 2023;14:1215450 (Aug 23). doi: 10.3389/fimmu.2023.1215450

Key clinical point: Tofacitinib combined with iguratimod relieves clinical symptoms and results in a higher response rate compared with conventional synthetic disease-modifying antirheumatic drugs (csDMARD) in patients with rheumatoid arthritis with usual interstitial pneumonia (RA-UIP).

Major finding: After 6 months, treatment with tofacitinib + iguratimod vs csDMARD significantly improved forced vital capacity percentage (P = .031) and high-resolution computed tomography fibrosis score (P = .015) and resulted in a higher overall response rate (66.7% vs 35.7%; P = .027), with no patients discontinuing tofacitinib or iguratimod due to side effects or poor efficacy.

Study details:This prospective observational cohort study included 78 patients with RA-UIP who received tofacitinib + iguratimod, csDMARD + iguratimod, or csDMARD.

Disclosures: This study did not declare any specific funding source. The authors declared no conflicts of interest.

Source: Wang S et al. A prospective observational cohort study of the efficacy of tofacitinib plus iguratimod on rheumatoid arthritis with usual interstitial pneumonia. Front Immunol. 2023;14:1215450 (Aug 23). doi: 10.3389/fimmu.2023.1215450

Key clinical point: Tofacitinib combined with iguratimod relieves clinical symptoms and results in a higher response rate compared with conventional synthetic disease-modifying antirheumatic drugs (csDMARD) in patients with rheumatoid arthritis with usual interstitial pneumonia (RA-UIP).

Major finding: After 6 months, treatment with tofacitinib + iguratimod vs csDMARD significantly improved forced vital capacity percentage (P = .031) and high-resolution computed tomography fibrosis score (P = .015) and resulted in a higher overall response rate (66.7% vs 35.7%; P = .027), with no patients discontinuing tofacitinib or iguratimod due to side effects or poor efficacy.

Study details:This prospective observational cohort study included 78 patients with RA-UIP who received tofacitinib + iguratimod, csDMARD + iguratimod, or csDMARD.

Disclosures: This study did not declare any specific funding source. The authors declared no conflicts of interest.

Source: Wang S et al. A prospective observational cohort study of the efficacy of tofacitinib plus iguratimod on rheumatoid arthritis with usual interstitial pneumonia. Front Immunol. 2023;14:1215450 (Aug 23). doi: 10.3389/fimmu.2023.1215450

Key clinical point: First-line biologic treatment with tocilizumab significantly reduced disease activity scores and demonstrated a good safety profile in a real-world cohort of patients with rheumatoid arthritis (RA) who had had an inadequate response to disease-modifying antirheumatic drugs (DMARD-IR).

Major finding: At 12 months, tocilizumab treatment led to significant reductions in disease activity scores (all P < .001), with 85.5% of patients receiving tocilizumab achieving remission or low disease activity according to the Disease Activity Score of 28 Joints; however, 22.0% of patients switched to other biologic DMARD either due to inefficacy or side effects.

Study details: Findings are from an analysis of 258 patients with RA from the TReasure Registry who were DMARD-IR and received first-line biologic therapy with tocilizumab as monotherapy (n = 80) or in combination with conventional synthetic DMARD (n = 178).

Disclosures: This study was sponsored by Roche Pharmaceuticals, Turkey, and funded by Hacettepe Rheumatology Society, Ankara. Some authors, including the lead author, declared receiving research support, consulting fees, or honoraria from and having other ties with Roche and other sources.

Source: Karadag O et al. Tocilizumab as a first line biologic agent in rheumatoid arthritis patients with inadequate response to disease-modifying anti-rheumatic drugs: Real life experience from the TReasure Registry. Clin Exp Rheumatol. 2023 (Aug 29). doi: 10.55563/clinexprheumatol/2h6ma1

Key clinical point: First-line biologic treatment with tocilizumab significantly reduced disease activity scores and demonstrated a good safety profile in a real-world cohort of patients with rheumatoid arthritis (RA) who had had an inadequate response to disease-modifying antirheumatic drugs (DMARD-IR).

Major finding: At 12 months, tocilizumab treatment led to significant reductions in disease activity scores (all P < .001), with 85.5% of patients receiving tocilizumab achieving remission or low disease activity according to the Disease Activity Score of 28 Joints; however, 22.0% of patients switched to other biologic DMARD either due to inefficacy or side effects.

Study details: Findings are from an analysis of 258 patients with RA from the TReasure Registry who were DMARD-IR and received first-line biologic therapy with tocilizumab as monotherapy (n = 80) or in combination with conventional synthetic DMARD (n = 178).

Disclosures: This study was sponsored by Roche Pharmaceuticals, Turkey, and funded by Hacettepe Rheumatology Society, Ankara. Some authors, including the lead author, declared receiving research support, consulting fees, or honoraria from and having other ties with Roche and other sources.

Source: Karadag O et al. Tocilizumab as a first line biologic agent in rheumatoid arthritis patients with inadequate response to disease-modifying anti-rheumatic drugs: Real life experience from the TReasure Registry. Clin Exp Rheumatol. 2023 (Aug 29). doi: 10.55563/clinexprheumatol/2h6ma1

Key clinical point: First-line biologic treatment with tocilizumab significantly reduced disease activity scores and demonstrated a good safety profile in a real-world cohort of patients with rheumatoid arthritis (RA) who had had an inadequate response to disease-modifying antirheumatic drugs (DMARD-IR).

Major finding: At 12 months, tocilizumab treatment led to significant reductions in disease activity scores (all P < .001), with 85.5% of patients receiving tocilizumab achieving remission or low disease activity according to the Disease Activity Score of 28 Joints; however, 22.0% of patients switched to other biologic DMARD either due to inefficacy or side effects.

Study details: Findings are from an analysis of 258 patients with RA from the TReasure Registry who were DMARD-IR and received first-line biologic therapy with tocilizumab as monotherapy (n = 80) or in combination with conventional synthetic DMARD (n = 178).

Disclosures: This study was sponsored by Roche Pharmaceuticals, Turkey, and funded by Hacettepe Rheumatology Society, Ankara. Some authors, including the lead author, declared receiving research support, consulting fees, or honoraria from and having other ties with Roche and other sources.

Source: Karadag O et al. Tocilizumab as a first line biologic agent in rheumatoid arthritis patients with inadequate response to disease-modifying anti-rheumatic drugs: Real life experience from the TReasure Registry. Clin Exp Rheumatol. 2023 (Aug 29). doi: 10.55563/clinexprheumatol/2h6ma1

Key clinical point: Patients with early rheumatoid arthritis (RA) presenting with mono- or oligo-arthritis and high perceived disease impact as assessed by Patient Global Assessment (PGA) scores have severe persistent fatigue over time and may benefit from early nonpharmacologic interventions for fatigue.

Major finding: During the 5-year follow-up, the average fatigue score was significantly higher in patients presenting with mono-arthritis (mean difference in fatigue score [β] +4.3 mm; P = .038) and oligo-arthritis (β +4.8 mm; P = .001) vs poly-arthritis at diagnosis, whereas it was significantly lower in patients presenting with poly-arthritis and low PGA scores vs mono- or oligo-arthritis and high PGA scores (β −20 mm; P < .001).

Study details: This study evaluated 1560 and 415 patients with early RA from the Leiden Early Arthritis Cohort and the Treatment in the Rotterdam Early Arthritis Cohort, respectively.

Disclosures: This study was supported by the European Research Council and the Dutch Arthritis Society. The authors declared no conflicts of interest.

Source: Boeren AMP et al. Rheumatoid arthritis presenting with mono- or oligo-arthritis and high VAS remains most fatigued during 5-years follow-up. Rheumatology (Oxford). 2023 (Aug 26). doi: 10.1093/rheumatology/kead429

Key clinical point: Patients with early rheumatoid arthritis (RA) presenting with mono- or oligo-arthritis and high perceived disease impact as assessed by Patient Global Assessment (PGA) scores have severe persistent fatigue over time and may benefit from early nonpharmacologic interventions for fatigue.

Major finding: During the 5-year follow-up, the average fatigue score was significantly higher in patients presenting with mono-arthritis (mean difference in fatigue score [β] +4.3 mm; P = .038) and oligo-arthritis (β +4.8 mm; P = .001) vs poly-arthritis at diagnosis, whereas it was significantly lower in patients presenting with poly-arthritis and low PGA scores vs mono- or oligo-arthritis and high PGA scores (β −20 mm; P < .001).

Study details: This study evaluated 1560 and 415 patients with early RA from the Leiden Early Arthritis Cohort and the Treatment in the Rotterdam Early Arthritis Cohort, respectively.

Disclosures: This study was supported by the European Research Council and the Dutch Arthritis Society. The authors declared no conflicts of interest.

Source: Boeren AMP et al. Rheumatoid arthritis presenting with mono- or oligo-arthritis and high VAS remains most fatigued during 5-years follow-up. Rheumatology (Oxford). 2023 (Aug 26). doi: 10.1093/rheumatology/kead429

Key clinical point: Patients with early rheumatoid arthritis (RA) presenting with mono- or oligo-arthritis and high perceived disease impact as assessed by Patient Global Assessment (PGA) scores have severe persistent fatigue over time and may benefit from early nonpharmacologic interventions for fatigue.

Major finding: During the 5-year follow-up, the average fatigue score was significantly higher in patients presenting with mono-arthritis (mean difference in fatigue score [β] +4.3 mm; P = .038) and oligo-arthritis (β +4.8 mm; P = .001) vs poly-arthritis at diagnosis, whereas it was significantly lower in patients presenting with poly-arthritis and low PGA scores vs mono- or oligo-arthritis and high PGA scores (β −20 mm; P < .001).

Study details: This study evaluated 1560 and 415 patients with early RA from the Leiden Early Arthritis Cohort and the Treatment in the Rotterdam Early Arthritis Cohort, respectively.

Disclosures: This study was supported by the European Research Council and the Dutch Arthritis Society. The authors declared no conflicts of interest.

Source: Boeren AMP et al. Rheumatoid arthritis presenting with mono- or oligo-arthritis and high VAS remains most fatigued during 5-years follow-up. Rheumatology (Oxford). 2023 (Aug 26). doi: 10.1093/rheumatology/kead429

Key clinical point: In patients with newly diagnosed rheumatoid arthritis (RA), initial glucocorticoid bridging (GB) led to more rapid clinical improvements than non-bridging, without any apparent risk for increased glucocorticoid use after the intended bridging period.

Major finding: The risk of using glucocorticoids at 12 months was higher in the GB vs non-bridging group, but this risk reduced over time and was not significantly different at 18 and 24 months. The cumulative doses did not differ significantly between groups after the planned bridging schedule. Patients in the GB group showed more rapid improvements in the mean Disease Activity Score of 28 Joints during the first 6 months (P < .001).

Study details: This individual patient data meta-analysis combined data from three randomized clinical trials and included 625 patients with newly diagnosed RA who received conventional synthetic disease-modifying antirheumatic drugs with (n = 252) or without (n = 373) initial GB.

Disclosures: This study did not declare any specific funding source. Some authors declared receiving consultancy or speaker honoraria, fees, or grants from or providing expert advice or testimony for or serving as chair for various sources.

Source: van Ouwerkerk L et al. Initial glucocorticoid bridging in rheumatoid arthritis: Does it affect glucocorticoid use over time? Ann Rheum Dis. 2023 (Aug 22). doi: 10.1136/ard-2023-224270

Key clinical point: In patients with newly diagnosed rheumatoid arthritis (RA), initial glucocorticoid bridging (GB) led to more rapid clinical improvements than non-bridging, without any apparent risk for increased glucocorticoid use after the intended bridging period.

Major finding: The risk of using glucocorticoids at 12 months was higher in the GB vs non-bridging group, but this risk reduced over time and was not significantly different at 18 and 24 months. The cumulative doses did not differ significantly between groups after the planned bridging schedule. Patients in the GB group showed more rapid improvements in the mean Disease Activity Score of 28 Joints during the first 6 months (P < .001).

Study details: This individual patient data meta-analysis combined data from three randomized clinical trials and included 625 patients with newly diagnosed RA who received conventional synthetic disease-modifying antirheumatic drugs with (n = 252) or without (n = 373) initial GB.

Disclosures: This study did not declare any specific funding source. Some authors declared receiving consultancy or speaker honoraria, fees, or grants from or providing expert advice or testimony for or serving as chair for various sources.

Source: van Ouwerkerk L et al. Initial glucocorticoid bridging in rheumatoid arthritis: Does it affect glucocorticoid use over time? Ann Rheum Dis. 2023 (Aug 22). doi: 10.1136/ard-2023-224270

Key clinical point: In patients with newly diagnosed rheumatoid arthritis (RA), initial glucocorticoid bridging (GB) led to more rapid clinical improvements than non-bridging, without any apparent risk for increased glucocorticoid use after the intended bridging period.

Major finding: The risk of using glucocorticoids at 12 months was higher in the GB vs non-bridging group, but this risk reduced over time and was not significantly different at 18 and 24 months. The cumulative doses did not differ significantly between groups after the planned bridging schedule. Patients in the GB group showed more rapid improvements in the mean Disease Activity Score of 28 Joints during the first 6 months (P < .001).

Study details: This individual patient data meta-analysis combined data from three randomized clinical trials and included 625 patients with newly diagnosed RA who received conventional synthetic disease-modifying antirheumatic drugs with (n = 252) or without (n = 373) initial GB.

Disclosures: This study did not declare any specific funding source. Some authors declared receiving consultancy or speaker honoraria, fees, or grants from or providing expert advice or testimony for or serving as chair for various sources.

Source: van Ouwerkerk L et al. Initial glucocorticoid bridging in rheumatoid arthritis: Does it affect glucocorticoid use over time? Ann Rheum Dis. 2023 (Aug 22). doi: 10.1136/ard-2023-224270

Key clinical point: In patients with newly diagnosed rheumatoid arthritis (RA), initial glucocorticoid bridging (GB) led to more rapid clinical improvements than non-bridging, without any apparent risk for increased glucocorticoid use after the intended bridging period.

Major finding: The risk of using glucocorticoids at 12 months was higher in the GB vs non-bridging group, but this risk reduced over time and was not significantly different at 18 and 24 months. The cumulative doses did not differ significantly between groups after the planned bridging schedule. Patients in the GB group showed more rapid improvements in the mean Disease Activity Score of 28 Joints during the first 6 months (P < .001).

Study details: This individual patient data meta-analysis combined data from three randomized clinical trials and included 625 patients with newly diagnosed RA who received conventional synthetic disease-modifying antirheumatic drugs with (n = 252) or without (n = 373) initial GB.

Disclosures: This study did not declare any specific funding source. Some authors declared receiving consultancy or speaker honoraria, fees, or grants from or providing expert advice or testimony for or serving as chair for various sources.

Source: van Ouwerkerk L et al. Initial glucocorticoid bridging in rheumatoid arthritis: Does it affect glucocorticoid use over time? Ann Rheum Dis. 2023 (Aug 22). doi: 10.1136/ard-2023-224270

Key clinical point: In patients with newly diagnosed rheumatoid arthritis (RA), initial glucocorticoid bridging (GB) led to more rapid clinical improvements than non-bridging, without any apparent risk for increased glucocorticoid use after the intended bridging period.

Major finding: The risk of using glucocorticoids at 12 months was higher in the GB vs non-bridging group, but this risk reduced over time and was not significantly different at 18 and 24 months. The cumulative doses did not differ significantly between groups after the planned bridging schedule. Patients in the GB group showed more rapid improvements in the mean Disease Activity Score of 28 Joints during the first 6 months (P < .001).

Study details: This individual patient data meta-analysis combined data from three randomized clinical trials and included 625 patients with newly diagnosed RA who received conventional synthetic disease-modifying antirheumatic drugs with (n = 252) or without (n = 373) initial GB.

Disclosures: This study did not declare any specific funding source. Some authors declared receiving consultancy or speaker honoraria, fees, or grants from or providing expert advice or testimony for or serving as chair for various sources.

Source: van Ouwerkerk L et al. Initial glucocorticoid bridging in rheumatoid arthritis: Does it affect glucocorticoid use over time? Ann Rheum Dis. 2023 (Aug 22). doi: 10.1136/ard-2023-224270

Key clinical point: In patients with newly diagnosed rheumatoid arthritis (RA), initial glucocorticoid bridging (GB) led to more rapid clinical improvements than non-bridging, without any apparent risk for increased glucocorticoid use after the intended bridging period.

Major finding: The risk of using glucocorticoids at 12 months was higher in the GB vs non-bridging group, but this risk reduced over time and was not significantly different at 18 and 24 months. The cumulative doses did not differ significantly between groups after the planned bridging schedule. Patients in the GB group showed more rapid improvements in the mean Disease Activity Score of 28 Joints during the first 6 months (P < .001).

Study details: This individual patient data meta-analysis combined data from three randomized clinical trials and included 625 patients with newly diagnosed RA who received conventional synthetic disease-modifying antirheumatic drugs with (n = 252) or without (n = 373) initial GB.

Disclosures: This study did not declare any specific funding source. Some authors declared receiving consultancy or speaker honoraria, fees, or grants from or providing expert advice or testimony for or serving as chair for various sources.

Source: van Ouwerkerk L et al. Initial glucocorticoid bridging in rheumatoid arthritis: Does it affect glucocorticoid use over time? Ann Rheum Dis. 2023 (Aug 22). doi: 10.1136/ard-2023-224270

Key clinical point: Patients with rheumatoid arthritis (RA) in long-standing remission had a significant risk of experiencing a disease flare if the tumor necrosis factor inhibitor (TNFi) dose is tapered to discontinuation, but most patients regained remission after the original TNFi dose was reinstated.

Major finding: The frequency of disease activity flares during the 12-month follow-up was significantly higher among patients who tapered TNFi to discontinuation vs those who continued with the stable dose (risk difference 58%; P < .0001). However, reinstatement of the initial TNFi dose led to comparable remission rates in both treatment groups.

Study details: Findings are from the phase 4 ARCTIC REWIND trial including 92 patients with RA in sustained remission for ≥ 1 year on stable TNFi therapy and without swollen joints at inclusion, who were randomly assigned to either tapering of their TNFi dose to discontinuation or to a continued stable TNFi dose.

Disclosures: This study was funded by the Research Council of Norway and South-Eastern Norway Regional Health Authority. Some authors declared receiving personal fees or grants from various sources, including the study funders.

Source: Lillegraven S et al. Effect of tapered versus stable treatment with tumour necrosis factor inhibitors on disease flares in patients with rheumatoid arthritis in remission: A randomised, open label, non-inferiority trial. Ann Rheum Dis. 2023 (Aug 22). doi: 10.1136/ard-2023-224476

Key clinical point: Patients with rheumatoid arthritis (RA) in long-standing remission had a significant risk of experiencing a disease flare if the tumor necrosis factor inhibitor (TNFi) dose is tapered to discontinuation, but most patients regained remission after the original TNFi dose was reinstated.

Major finding: The frequency of disease activity flares during the 12-month follow-up was significantly higher among patients who tapered TNFi to discontinuation vs those who continued with the stable dose (risk difference 58%; P < .0001). However, reinstatement of the initial TNFi dose led to comparable remission rates in both treatment groups.

Study details: Findings are from the phase 4 ARCTIC REWIND trial including 92 patients with RA in sustained remission for ≥ 1 year on stable TNFi therapy and without swollen joints at inclusion, who were randomly assigned to either tapering of their TNFi dose to discontinuation or to a continued stable TNFi dose.

Disclosures: This study was funded by the Research Council of Norway and South-Eastern Norway Regional Health Authority. Some authors declared receiving personal fees or grants from various sources, including the study funders.

Source: Lillegraven S et al. Effect of tapered versus stable treatment with tumour necrosis factor inhibitors on disease flares in patients with rheumatoid arthritis in remission: A randomised, open label, non-inferiority trial. Ann Rheum Dis. 2023 (Aug 22). doi: 10.1136/ard-2023-224476

Key clinical point: Patients with rheumatoid arthritis (RA) in long-standing remission had a significant risk of experiencing a disease flare if the tumor necrosis factor inhibitor (TNFi) dose is tapered to discontinuation, but most patients regained remission after the original TNFi dose was reinstated.

Major finding: The frequency of disease activity flares during the 12-month follow-up was significantly higher among patients who tapered TNFi to discontinuation vs those who continued with the stable dose (risk difference 58%; P < .0001). However, reinstatement of the initial TNFi dose led to comparable remission rates in both treatment groups.

Study details: Findings are from the phase 4 ARCTIC REWIND trial including 92 patients with RA in sustained remission for ≥ 1 year on stable TNFi therapy and without swollen joints at inclusion, who were randomly assigned to either tapering of their TNFi dose to discontinuation or to a continued stable TNFi dose.

Disclosures: This study was funded by the Research Council of Norway and South-Eastern Norway Regional Health Authority. Some authors declared receiving personal fees or grants from various sources, including the study funders.

Source: Lillegraven S et al. Effect of tapered versus stable treatment with tumour necrosis factor inhibitors on disease flares in patients with rheumatoid arthritis in remission: A randomised, open label, non-inferiority trial. Ann Rheum Dis. 2023 (Aug 22). doi: 10.1136/ard-2023-224476

Key clinical point: The administration of low-dose glucocorticoids over 2 years resulted in a modest weight gain of ~1 kg but had no effect on blood pressure (BP) in patients with early and established rheumatoid arthritis (RA).

Major finding: After 2 years, participants in both the low-dose glucocorticoid and control groups gained weight, but the low-dose glucocorticoid group gained an additional 1.1 kg of body weight (P < .001), with no significant between-group differences in the mean arterial pressure (P = .187).

Study details: Findings are from a pooled analysis of five randomized controlled trials including 1112 patients with early and established RA who received low-dose glucocorticoids (≤7.5 mg/day of prednisone equivalent; n = 548) or control treatment (n = 564) over at least 2 years.

Disclosures: This study did not receive any specific funding. Some authors declared receiving investigator fees, grants or contracts, consulting fees, payments or honoraria, or support for attending meetings or travel from or owning stocks or options in various sources.

Source: Palmowski A et al. The effect of low-dose glucocorticoids over two years on weight and blood pressure in rheumatoid arthritis: Individual patient data from five randomized trials. Ann Intern Med. 2023 (Aug 15). doi: 10.7326/M23-0192

Key clinical point: The administration of low-dose glucocorticoids over 2 years resulted in a modest weight gain of ~1 kg but had no effect on blood pressure (BP) in patients with early and established rheumatoid arthritis (RA).

Major finding: After 2 years, participants in both the low-dose glucocorticoid and control groups gained weight, but the low-dose glucocorticoid group gained an additional 1.1 kg of body weight (P < .001), with no significant between-group differences in the mean arterial pressure (P = .187).

Study details: Findings are from a pooled analysis of five randomized controlled trials including 1112 patients with early and established RA who received low-dose glucocorticoids (≤7.5 mg/day of prednisone equivalent; n = 548) or control treatment (n = 564) over at least 2 years.

Disclosures: This study did not receive any specific funding. Some authors declared receiving investigator fees, grants or contracts, consulting fees, payments or honoraria, or support for attending meetings or travel from or owning stocks or options in various sources.

Source: Palmowski A et al. The effect of low-dose glucocorticoids over two years on weight and blood pressure in rheumatoid arthritis: Individual patient data from five randomized trials. Ann Intern Med. 2023 (Aug 15). doi: 10.7326/M23-0192

Key clinical point: The administration of low-dose glucocorticoids over 2 years resulted in a modest weight gain of ~1 kg but had no effect on blood pressure (BP) in patients with early and established rheumatoid arthritis (RA).

Major finding: After 2 years, participants in both the low-dose glucocorticoid and control groups gained weight, but the low-dose glucocorticoid group gained an additional 1.1 kg of body weight (P < .001), with no significant between-group differences in the mean arterial pressure (P = .187).

Study details: Findings are from a pooled analysis of five randomized controlled trials including 1112 patients with early and established RA who received low-dose glucocorticoids (≤7.5 mg/day of prednisone equivalent; n = 548) or control treatment (n = 564) over at least 2 years.

Disclosures: This study did not receive any specific funding. Some authors declared receiving investigator fees, grants or contracts, consulting fees, payments or honoraria, or support for attending meetings or travel from or owning stocks or options in various sources.

Source: Palmowski A et al. The effect of low-dose glucocorticoids over two years on weight and blood pressure in rheumatoid arthritis: Individual patient data from five randomized trials. Ann Intern Med. 2023 (Aug 15). doi: 10.7326/M23-0192

In a new salvo in the dispute over the wisdom of early “bridging” treatment with glucocorticoids in rheumatoid arthritis, Dutch researchers suggested in a new meta-analysis that the American College of Rheumatology guideline is too cautious.

The report, published in Annals of the Rheumatic Diseases, examined three randomized trials of bridging versus nonbridging. The findings “emphasize the benefits of bridging therapy and shows that bridgers are not using more glucocorticoids after their intended bridging period, compared with nonbridgers, during a 2-year follow-up,” study coauthor Sytske Anne Bergstra, PhD, a postdoctoral researcher at Leiden (the Netherlands) University Medical Center, said in an interview.

However, an American researcher who helped create the 2021 ACR guideline is unmoved by the new report. “This publication didn’t do anything to assuage my concerns,” Joel Kremer, MD, founder and president of the Corrona Research Foundation and professor of medicine emeritus at Albany (N.Y.) Medical College, said in an interview.

At issue is whether patients with early RA should be temporarily treated with glucocorticoids in order to provide rapid relief. The ACR’s 2021 guideline on the treatment of RA says short-term glucocorticoids should not be “systematically prescribed” but notes that they are still “frequently necessary to alleviate symptoms” before disease-modifying therapies are given. The guideline adds that “these recommendations were made in recognition of the frequent difficulty tapering glucocorticoids, leading to undesirable prolonged use and the increasing evidence of the negative impact of glucocorticoids on long-term patient outcomes, including risk for infection, osteoporosis, and cardiovascular disease, in RA and other rheumatic diseases.”

For its part, the European Alliance of Associations for Rheumatology’s 2022 recommendations state that short-term glucocorticoids “should be considered when initiating or changing [disease-modifying antirheumatic drugs], in different dose regimens and routes of administration, but should be tapered and discontinued as rapidly as clinically feasible.”

Members of the Dutch team behind the new meta-analysis have been supporters of “bridging” therapy. For the new report, they analyzed three studies, including one led by a member of the team. Each study had at least one arm that randomized patients with RA to glucocorticoid bridging. Patients also took disease-modifying antirheumatic drugs (DMARDs).

There were 252 patients in study arms that started with bridging (mean age, 52 years; 68% female) and 373 other patients (mean age, 53 years; 67% female).

The researchers found that glucocorticoid use was higher in the bridgers at 12 months (odds ratio, 3.27; 95% confidence interval, 1.06-10.08), but the excess risk at 18 months (OR, 1.60; 95% CI, 0.46-5.60) and 24 months (OR, 1.70; 95% CI, 0.58-4.97) dipped below statistical significance. Also, they reported that “bridgers improved more rapidly (P < .001) in the first 6 months and the bridgers required significantly fewer changes in DMARDs (incidence rate ratio, 0.59; 95% CI, 0.38-0.94).”

“Based on our results, combined with two earlier publications [here and here], we show that most patients included in clinical trials with protocolized tapering schedules are able to stop glucocorticoids after bridging,” Dr. Bergstra said. “We also confirm the well-known short-term clinical effects and show that patients using glucocorticoid bridging require fewer DMARD changes. For a re-evaluation of the ACR guideline, this evidence should be combined with the extensive evidence showing short- as well as long-term clinical benefits of glucocorticoid bridging but also with evidence on potential side effects at different doses.”

She added that “implementing predefined tapering protocols may help clinicians and patients to stop glucocorticoids after bridging.” As for limitations, “patients included in these trials may differ from patients in clinical practice. We cannot be sure whether these results can be generalized to the full patient population.”

Mitchel L. Zoler/MDedge News

Dr. Kremer, a coauthor of the ACR guideline, pointed out that the patients who took glucocorticoids early were much more likely to be on them at 12 months.

By definition, “bridging” is temporary, he said, a brief period to help patients tolerate RA until DMARDs kick in. But in the studies, many of the patients clearly took the drugs for extended periods of time. In those cases, “it not a bridge,” and the risk is that “you’re treating people with a lifelong disease with doses of glucocorticoids that have been shown in multiple studies to be dangerous.”

He added that, while the excess likelihood of these patients staying on the drugs at 18 or 24 months wasn’t deemed to be statistically significant in the meta-analysis, the confidence intervals were unusually wide. That raises questions about whether some of the patients actually stay on the drugs.

Dr. Kremer said it can still be appropriate to give glucocorticoids to patients in distress, although it’s crucial in those cases to take the patients off them as soon as possible. It’s best, though, to not prescribe them at all. “If you can avoid it,” he said, “definitely avoid it.”

The study was conducted without outside funding. Dr. Bergstra reported receiving grant funding from Pfizer, and some of the other study authors reported various relationships with industry. Dr. Kremer had no relevant disclosures.

In a new salvo in the dispute over the wisdom of early “bridging” treatment with glucocorticoids in rheumatoid arthritis, Dutch researchers suggested in a new meta-analysis that the American College of Rheumatology guideline is too cautious.

The report, published in Annals of the Rheumatic Diseases, examined three randomized trials of bridging versus nonbridging. The findings “emphasize the benefits of bridging therapy and shows that bridgers are not using more glucocorticoids after their intended bridging period, compared with nonbridgers, during a 2-year follow-up,” study coauthor Sytske Anne Bergstra, PhD, a postdoctoral researcher at Leiden (the Netherlands) University Medical Center, said in an interview.

However, an American researcher who helped create the 2021 ACR guideline is unmoved by the new report. “This publication didn’t do anything to assuage my concerns,” Joel Kremer, MD, founder and president of the Corrona Research Foundation and professor of medicine emeritus at Albany (N.Y.) Medical College, said in an interview.

At issue is whether patients with early RA should be temporarily treated with glucocorticoids in order to provide rapid relief. The ACR’s 2021 guideline on the treatment of RA says short-term glucocorticoids should not be “systematically prescribed” but notes that they are still “frequently necessary to alleviate symptoms” before disease-modifying therapies are given. The guideline adds that “these recommendations were made in recognition of the frequent difficulty tapering glucocorticoids, leading to undesirable prolonged use and the increasing evidence of the negative impact of glucocorticoids on long-term patient outcomes, including risk for infection, osteoporosis, and cardiovascular disease, in RA and other rheumatic diseases.”

For its part, the European Alliance of Associations for Rheumatology’s 2022 recommendations state that short-term glucocorticoids “should be considered when initiating or changing [disease-modifying antirheumatic drugs], in different dose regimens and routes of administration, but should be tapered and discontinued as rapidly as clinically feasible.”

Members of the Dutch team behind the new meta-analysis have been supporters of “bridging” therapy. For the new report, they analyzed three studies, including one led by a member of the team. Each study had at least one arm that randomized patients with RA to glucocorticoid bridging. Patients also took disease-modifying antirheumatic drugs (DMARDs).

There were 252 patients in study arms that started with bridging (mean age, 52 years; 68% female) and 373 other patients (mean age, 53 years; 67% female).

The researchers found that glucocorticoid use was higher in the bridgers at 12 months (odds ratio, 3.27; 95% confidence interval, 1.06-10.08), but the excess risk at 18 months (OR, 1.60; 95% CI, 0.46-5.60) and 24 months (OR, 1.70; 95% CI, 0.58-4.97) dipped below statistical significance. Also, they reported that “bridgers improved more rapidly (P < .001) in the first 6 months and the bridgers required significantly fewer changes in DMARDs (incidence rate ratio, 0.59; 95% CI, 0.38-0.94).”

“Based on our results, combined with two earlier publications [here and here], we show that most patients included in clinical trials with protocolized tapering schedules are able to stop glucocorticoids after bridging,” Dr. Bergstra said. “We also confirm the well-known short-term clinical effects and show that patients using glucocorticoid bridging require fewer DMARD changes. For a re-evaluation of the ACR guideline, this evidence should be combined with the extensive evidence showing short- as well as long-term clinical benefits of glucocorticoid bridging but also with evidence on potential side effects at different doses.”

She added that “implementing predefined tapering protocols may help clinicians and patients to stop glucocorticoids after bridging.” As for limitations, “patients included in these trials may differ from patients in clinical practice. We cannot be sure whether these results can be generalized to the full patient population.”

Mitchel L. Zoler/MDedge News

Dr. Kremer, a coauthor of the ACR guideline, pointed out that the patients who took glucocorticoids early were much more likely to be on them at 12 months.

By definition, “bridging” is temporary, he said, a brief period to help patients tolerate RA until DMARDs kick in. But in the studies, many of the patients clearly took the drugs for extended periods of time. In those cases, “it not a bridge,” and the risk is that “you’re treating people with a lifelong disease with doses of glucocorticoids that have been shown in multiple studies to be dangerous.”

He added that, while the excess likelihood of these patients staying on the drugs at 18 or 24 months wasn’t deemed to be statistically significant in the meta-analysis, the confidence intervals were unusually wide. That raises questions about whether some of the patients actually stay on the drugs.

Dr. Kremer said it can still be appropriate to give glucocorticoids to patients in distress, although it’s crucial in those cases to take the patients off them as soon as possible. It’s best, though, to not prescribe them at all. “If you can avoid it,” he said, “definitely avoid it.”

The study was conducted without outside funding. Dr. Bergstra reported receiving grant funding from Pfizer, and some of the other study authors reported various relationships with industry. Dr. Kremer had no relevant disclosures.

In a new salvo in the dispute over the wisdom of early “bridging” treatment with glucocorticoids in rheumatoid arthritis, Dutch researchers suggested in a new meta-analysis that the American College of Rheumatology guideline is too cautious.

The report, published in Annals of the Rheumatic Diseases, examined three randomized trials of bridging versus nonbridging. The findings “emphasize the benefits of bridging therapy and shows that bridgers are not using more glucocorticoids after their intended bridging period, compared with nonbridgers, during a 2-year follow-up,” study coauthor Sytske Anne Bergstra, PhD, a postdoctoral researcher at Leiden (the Netherlands) University Medical Center, said in an interview.

However, an American researcher who helped create the 2021 ACR guideline is unmoved by the new report. “This publication didn’t do anything to assuage my concerns,” Joel Kremer, MD, founder and president of the Corrona Research Foundation and professor of medicine emeritus at Albany (N.Y.) Medical College, said in an interview.

At issue is whether patients with early RA should be temporarily treated with glucocorticoids in order to provide rapid relief. The ACR’s 2021 guideline on the treatment of RA says short-term glucocorticoids should not be “systematically prescribed” but notes that they are still “frequently necessary to alleviate symptoms” before disease-modifying therapies are given. The guideline adds that “these recommendations were made in recognition of the frequent difficulty tapering glucocorticoids, leading to undesirable prolonged use and the increasing evidence of the negative impact of glucocorticoids on long-term patient outcomes, including risk for infection, osteoporosis, and cardiovascular disease, in RA and other rheumatic diseases.”

For its part, the European Alliance of Associations for Rheumatology’s 2022 recommendations state that short-term glucocorticoids “should be considered when initiating or changing [disease-modifying antirheumatic drugs], in different dose regimens and routes of administration, but should be tapered and discontinued as rapidly as clinically feasible.”

Members of the Dutch team behind the new meta-analysis have been supporters of “bridging” therapy. For the new report, they analyzed three studies, including one led by a member of the team. Each study had at least one arm that randomized patients with RA to glucocorticoid bridging. Patients also took disease-modifying antirheumatic drugs (DMARDs).

There were 252 patients in study arms that started with bridging (mean age, 52 years; 68% female) and 373 other patients (mean age, 53 years; 67% female).

The researchers found that glucocorticoid use was higher in the bridgers at 12 months (odds ratio, 3.27; 95% confidence interval, 1.06-10.08), but the excess risk at 18 months (OR, 1.60; 95% CI, 0.46-5.60) and 24 months (OR, 1.70; 95% CI, 0.58-4.97) dipped below statistical significance. Also, they reported that “bridgers improved more rapidly (P < .001) in the first 6 months and the bridgers required significantly fewer changes in DMARDs (incidence rate ratio, 0.59; 95% CI, 0.38-0.94).”

“Based on our results, combined with two earlier publications [here and here], we show that most patients included in clinical trials with protocolized tapering schedules are able to stop glucocorticoids after bridging,” Dr. Bergstra said. “We also confirm the well-known short-term clinical effects and show that patients using glucocorticoid bridging require fewer DMARD changes. For a re-evaluation of the ACR guideline, this evidence should be combined with the extensive evidence showing short- as well as long-term clinical benefits of glucocorticoid bridging but also with evidence on potential side effects at different doses.”

She added that “implementing predefined tapering protocols may help clinicians and patients to stop glucocorticoids after bridging.” As for limitations, “patients included in these trials may differ from patients in clinical practice. We cannot be sure whether these results can be generalized to the full patient population.”

Mitchel L. Zoler/MDedge News

Dr. Kremer, a coauthor of the ACR guideline, pointed out that the patients who took glucocorticoids early were much more likely to be on them at 12 months.

By definition, “bridging” is temporary, he said, a brief period to help patients tolerate RA until DMARDs kick in. But in the studies, many of the patients clearly took the drugs for extended periods of time. In those cases, “it not a bridge,” and the risk is that “you’re treating people with a lifelong disease with doses of glucocorticoids that have been shown in multiple studies to be dangerous.”

He added that, while the excess likelihood of these patients staying on the drugs at 18 or 24 months wasn’t deemed to be statistically significant in the meta-analysis, the confidence intervals were unusually wide. That raises questions about whether some of the patients actually stay on the drugs.

Dr. Kremer said it can still be appropriate to give glucocorticoids to patients in distress, although it’s crucial in those cases to take the patients off them as soon as possible. It’s best, though, to not prescribe them at all. “If you can avoid it,” he said, “definitely avoid it.”

The study was conducted without outside funding. Dr. Bergstra reported receiving grant funding from Pfizer, and some of the other study authors reported various relationships with industry. Dr. Kremer had no relevant disclosures.