Publications

Can Patients with Controlled Rheumatoid Arthritis Taper Methotrexate From Targeted Therapy and Sustain Remission? A Systematic Review and Meta-analysis

J Rheumatol. 2023;50(1):36–47 doi: 10.3899/jrheum.220152

Meng CF,

Rajesh DA,

Jannat-Khah DP,

Jivanelli B,

Bykerk VP

This systematic review and meta-analysis of studies evaluated the proportion of patients in remission after the dosage of MTX was tapered, and concludes that patients with controlled RA may taper MTX from targeted therapy with a 10% reduction in the ability to sustain remission for up to 18 months.

Keywords:

• Efficacy,
• Meta analysis,
• Dosing,
• Review

Analysis of Disease Activity Metrics in a Methotrexate Withdrawal Study among Patients with Rheumatoid Arthritis Treated with Tofacitinib plus Methotrexate

Rheumatol Ther. 2022. Epub ahead of print doi: 10.1007/s40744-022-00511-3

Fleischmann R,

Haraoui B,

Buch MH,

Gold D,

Sawyerr G,

Shi H,

Diehl A,

Lee K

This post hoc analysis of data from the ORAL Shift study, concludes that DAS28-4(ESR), CDAI remission and SDAI remission are the metrics most likely to reflect actual disease activity, in the context of tofacitinib in a randomised withdrawal of MTX.

Keywords:

• JAK,
• Tofacitinib,
• Efficacy,
• Dosing

Response to secukinumab on synovitis using Power Doppler ultrasound in psoriatic arthritis: 12-week results from a phase III study, ULTIMATE

doi: 10.1093/rheumatology/keab628

D'Agostino MA,

Schett G,

López-Rdz A,

Šenolt L,

Fazekas K,

Burgos-Vargas R,

Maldonado-Cocco J,

Naredo E,

Carron P,

Duggan AM,

Goyanka P,

Boers M,

Gaillez C

D'Agostino, et al. aimed to evaluate whether treatment with secukinumab inhibits synovitis in patients with active PsA, as measured by PDUS. They found that secukinumab rapidly and significantly decreased synovitis, indicating a direct effect of IL-17 inhibition on the synovium in patients with PsA.

Keywords:

• IL-17,
• Secukinumab,
• Efficacy

Effect of dose adjustments on the efficacy and safety of tofacitinib in patients with rheumatoid arthritis: a post hoc analysis of an open-label, long-term extension study (ORAL Sequel)

Clin Rheumatol. 2022 Jan 1. Epub ahead of print doi: 10.1007/s10067-021-05908-z

Mueller RB,

Schulze-Koops H,

Furst DE,

Cohen SB,

Kwok K,

Wang L,

Killeen T,

von Kempis J

Post-hoc analysis shows that dosing up from tofacitinib 5 to 10 mg BID is associated with improved efficacy for up to 12 months, versus staying on 5 mg BID, and dosing down from 10 to 5 mg BID is not generally associated with a significant loss of efficacy.Although clinical trials have generally shown no significant differences, in terms of efficacy and safety, when switching tofacitinib dose up or down, these per-protocol switches are not directly informative for clinical decision-making in dai...

Keywords:

• JAK,
• Tofacitinib,
• Safety,
• Efficacy,
• Dosing

Safety, Tolerability, Pharmacokinetics, Target Occupancy, and QT Analysis of the Novel BTK Inhibitor Evobrutinib in Healthy Volunteers

Clin Transl Sci . 2020 Mar;13(2):325-336. doi: 10.1111/cts.12713. Epub 2019 Nov 29.

Becker A,

Martin EC,

Mitchell DY,

Grennigloh R,

Bender AT,

Mackenzie H and Johne A

In this first in-human phase I, double-blind, placebo-controlled trial, the Bruton’s tyrosine kinase (BTK) inhibitor evobrutinib was well-tolerated, showed linear and time-independent PK, induced long-lasting BTK inhibition, and was not associated with prolongation of QT/QTc interval in healthy subjects. Evobrutinib is an oral BTK inhibitor that has demonstrated efficacy in pre-clinical and autoimmune disease models. BTK is a key regulator of B cell receptor and Fc receptor signalling, and a rat...

Keywords:

• BTK,
• Evobrutinib,
• Safety,
• MOA

Outcomes of Dose Reduction, Withdrawal, and Restart of Tofacitinib in Patients with Rheumatoid Arthritis: A Prospective Observational Study

Clin Rheumatol. 2019 Aug 9. DOI: 10.1007/s10067-019-04721-z

Mori S,

Ueki Y

Following achievement of remission or low disease activity (LDA), a dose reduction strategy of TOF to a 5mg QD dose was preferable to immediate withdrawal of TOF, with lower relapse rates.Clinical remission or LDA early in the disease course is a target for every RA patient. Although maintaining a state of remission or LDA is beneficial to patients, the AEs and costs associated with DMARDs, have significant burdens on patients during life-long RA treatment. This long-term study was performed to ...

Keywords:

• JAK,
• Tofacitinib,
• Phase 4,
• Dosing

Comparison of Baricitinib, Upadacitinib, and Tofacitinib Mediated Regulation of Cytokine Signalling in Human Leukocyte Subpopulations

Arthritis Res Ther. 2019 Aug 2;21(1):183

McInnes IB,

Byers NL,

Higgs RE,

Lee J,

Macias WL,

Na S,

Ortmann RA,

Rocha G,

Rooney TP,

Wehrman T,

Zhang X,

Zuckerman SH,

Taylor PC

Different JAKinibs modulated distinct cytokine pathways to varying degrees, and no agent potently or continuously inhibited an individual cytokine signalling pathway throughout the dosing interval. This study aimed to compare the in vitro cellular pharmacology of BARI, TOF and UPA across relevant leukocyte subpopulations, coupled with their in vivo PK, to determine their effects on distinct cytokine pathways. Peripheral blood mononuclear cells from healthy donors were incubated with different JA...

Keywords:

• JAK,
• Baricitinib,
• Tofacitinib,
• Updacitinib,
• MOA

Professor Iain McInnes Reviews the Most Notable Papers from 2018

Please click the links below to go to the CSF review of each paper

McInnes. I

2018 brought a wealth of new data in cytokine signalling and IL-6 that helps inform current clinical practice and brings the promise of new options in the future. There was good data on the use of sub cutaneous tocilizumab as well as strategies in early RA and for methotrexate tapering. For the currently marketed JAK inhibitors, tofacitinib and baricitinib, continuous long-term efficacy and safety data further support its current use and applications. On the development side, the outcomes of the...

Keywords:

• Review

Influence of Age and Renal Impairment on the Steady State Pharmacokinetics of Filgotinib, a Selective JAK1 Inhibitor

Br J Clin Pharmacol 2018 Dec;84(12):2779-2789. DOI:10.1111/bcp.13726

Namour F,

Fagard L,

Van der AA,

Harrison P,

Xin Y,

Tasset C

Age and renal impairment (RI) had limited impact on the pharmacokinetics (PK) of filgotinib (FIL) but, in subjects with severe RI, exposure to the FIL metabolite was increased. FIL is a selective JAK1 inhibitor that is extensively, rapidly and proportionately absorbed after oral dosing from 50–200mg. Its major metabolite has a similar JAK1 selectivity profile but with reduced potency. In humans, exposure to the metabolite is higher by approximately 16–20 fold compared with the parent FIL. FIL an...

Keywords:

• JAK,
• Filgotinib,
• PK/PD

Pharmacokinetics of Upadacitinib with Clinical Regimens of the Extended-Release Formulation Utilized in Rheumatoid Arthritis Phase 3 Trials

Clin Pharmacol Drug Dev. 2019 Feb;8(2):208-216. doi: 10.1002/cpdd.462

Mohamed MEF,

Zeng J,

Marroum PJ,

Song IH,

Othman AA

Upadacitinib (UPA) extended release (ER) formulation dosing achieved the target profile that enables single dosing in patients with RA. In early clinical studies, UPA was given as an immediate release (IR) formulation, however patients were noted to experience fluctuations in blood plasma concentrations. To enhance patient compliance in UPA Phase 3 trials, ER tablets have been developed. Here, authors aimed at characterising the pharmacokinetics of UPA single and multiple doses of ER compared wi...

Keywords:

• JAK,
• Updacitinib,
• PK/PD