July 2023

The 2023 Pipeline of Disease-Modifying Antirheumatic Drugs (DMARDs) in Clinical Development for Spondyloarthritis (including psoriatic arthritis): a Systematic Review of Trials

RMD Open. 2023;9(3):e003279 doi 10.1136/rmdopen-2023-003279 https://pubmed.ncbi.nlm.nih.gov/37507210/

This systematic review identified DMARDs evaluated for axSpA and PsA, distinguishing between csDMARDs, tsDMARDs, and bDMARDs. The review pinpointed twenty-six distinct targeted therapies currently in clinical development; 18 therapies for axSpA and 15 therapies for PsA.

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Do Fatty Lesions Explain the Effect of Inflammation on New Syndesmophytes in Patients with Radiographic Axial Spondyloarthritis? Results From the SIAS Cohort and ASSERT Trial

RMD Open. 2023 9(3):e003118 doi: 10.1136/rmdopen-2023-003118

This study concluded that, in r-axSpA, vertebral corner inflammation may lead to syndesmophyte formation but in a minority of cases via visible fat deposition. Here, investigators aimed to determine how much of the effect of vertebral corner inflammation on the development of syndesmophytes is explained by vertebral corner fat deposition.

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A JAK Inhibitor for Treatment of Rheumatoid Arthritis: The Baricitinib Experience

J. Clin. Med. 2023;12(13):4527 doi 10.3390/jcm12134527

This review by Taylor, et al. reviews the long-term safety and efficacy data for baricitinib. Results from several studies showed that baricitinib has greater efficacy and survival compared to TNF inhibitors, and that the rate of CDAI <10 for baricitinib-treated RA patients increased over the course of seven years. Data also showed that remission rates were higher in real-world evidence than in RCTs.

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Baricitinib in Juvenile Idiopathic Arthritis: An International, Phase 3, Randomised, Double-blind, Placebo-controlled, Withdrawal, Efficacy, and Safety Trial

Lancet. 2023;402(10401):555–570 doi 10.1016/S0140-6736(23)00921-2

Phase 3 trial of baricitinib demonstrates efficacy with acceptable safety profile in polyarticular and extended oligoarticular juvenile idiopathic arthritis, juvenile psoriatic arthritis and enthesitis-related arthritis.

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Upadacitinib in Patients with Psoriatic Arthritis and Inadequate Response to Biologics: 3-year Results from the Open-Label Extension of the Randomised Controlled Phase 3 SELECT-PsA 2 Study

Clin Exp Rheumatol. 2023;41(11):2286–2297 doi: 10.55563/clinexprheumatol/8l7bbk.

Data from this open-label extension showed the efficacy of upadacitinib observed at 56 weeks was maintained through to 152 weeks in the treatment of patients with PsA. No cumulative adverse effects were observed, and no new safety signals were identified.

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Comparative Effectiveness of First-Line Baricitinib in Patients With Rheumatoid Arthritis in the Australian OPAL Data Set

ACR Open Rheumatol. 2023;5(7):345-353 doi 10.1002/acr2.11577

Cicirello, et al. present results showing that baricitinib is comparable in treatment persistence with TNF inhibitors. However, treatment persistence up to 24 months was significantly longer for baricitinib, but the effect size of one month is not clinically meaningful.

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June 2023

Mirikizumab as induction and maintenance therapy for ulcerative colitis

N Engl J Med 2023;388(26):2444–2455 doi: 10.1056/NEJMoa2207940

Mirikizumab was more effective than placebo in inducing and maintaining clinical remission in patients with moderately to severely active ulcerative colitis. D’Haens, et al. also noted that opportunistic infections and cancer developed in a small number of mirikizumab-treated patients.

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Tofacitinib versus Methotrexate as the First-line Disease-modifying Antirheumatic Drugs in the treatment of Rheumatoid Arthritis: An Open-label Randomized Controlled Trial

Int J Rheum Dis. 2023;26(9):1729–1736 doi: 10.1111/1756-185X.14801

This single-centre study by Khan, et al. suggests that high-dose methotrexate (25 mg/week, subcutaneously) may be as efficacious as tofacitinib in patients with established RA who are DMARD naïve or have not received a therapeutic dose of DMARDs.

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Sustained low functional impairment in axial spondyloarthritis (axSpA): Which are the primary outcomes that should be targeted to achieve this?

Arthritis Research & Therapy (2023) 25:70 https://pubmed.ncbi.nlm.nih.gov/37118833/

This real-world study showed that sustained BASDAI <3 may be a valid and feasible target for a treat-to-target strategy in AxSpA, having function as treatment goal.

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Effect of Body Mass Index on Treatment Response of Biologic/ Targeted-Synthetic DMARDs in Patients With Rheumatoid Arthritis, Psoriatic Arthritis or Axial Spondyloarthritis. A Systematic Review

Autoimmunity Reviews 22 (2023) 103357

The study demonstrated that obesity is a factor that could play a role in treatment decision-making in people living with inflammatory arthritis (IA). It appears that efficacy of TNFi is affected by patients’ weight/BMI in all forms of IA, while this is not the case for TCZ and ABA in RA, as well for IL-17 and IL-23 inhibitors in PsA.

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