February 2024

Efficacy and safety of JAK inhibitors in rheumatoid arthritis: update for the practising clinician

Nat Rev Rheumatol 2024;20(2):101–115 DOI: 10.1038/s41584-023-01062-9

The observed benefit:risk ratio strongly favours JAKi use in the majority of patients, and HCPs should consider and adhere to guidance on high-risk patients where applicable. Szekanecz et al summarised the safety and efficacy of approved JAKis tofacitinib, baricitinib, upadacitinib, and filgotinib to aid in clinical decision making.

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Continued JAK Inhibitor Treatment on the Risk of Recurrent Herpes Zoster Reactivation in Patients with Immune-mediated Inflammatory Diseases: A Nationwide Population-based Study in South Korea

Semin Arthritis Rheum 2024 doi 10.1016/j.semarthrit.2024.152362 Epub ahead of print

This real-world study by Kim, et al. found no significant relationship between continued JAK inhibitor therapy in patients with IMIDs and the risk of subsequent recurrent HZ reactivation. They also found no significant difference in the number of days patients were treated for HZ in the JAK inhibitor continuation and discontinuation groups.

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Abatacept in Individuals at High Risk of Rheumatoid Arthritis (APIPPRA): A Randomised, Double-blind, Multicentre, Parallel, Placebo-controlled, Phase 2b Clinical Trial

Lancet doi.org/10.1016/S0140-6736(23)02649-1

Therapeutic intervention during the at-risk phase of RA with abatacept is feasible, with acceptable safety profiles. However, the efficacy of intermittent administration at multiple intervals remains to be assessed.

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Impact of Upadacitinib on Laboratory Parameters and Related Adverse Events in Patients with RA: Integrated Data Up to 6.5 Years

Rheumatol Ther 2024;11(1):157–175 doi 10.1007/s40744-023-00624-3

Charles-Schoeman, et al. carried out a descriptive integrated analysis on patients with RA that were treated in the SELECT programme, with up to 6.5 years of exposure. They concluded that upadacitinib 15 mg QD had an acceptable safety profile, but long-term upadacitinib treatment was associated with dose-dependent laboratory abnormalities.

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Patient-reported outcomes in axial spondyloarthritis and psoriatic arthritis patients treated with secukinumab for 24 months in daily clinical practice

Semin Arthritis Rheum 2024;65:152388 DOI: 10.1016/j.semarthrit.2024.152388 Epub ahead of print

Secukinumab efficacy regarding PROs and retention rate was comparable between axSpA and PsA patient groups when adjusted for confounders. Christiansen et al compared 6-, 12- and 24-month pain, fatigue, PGA, and HAQ PROs in axSpA and PsA patients treated with secukinumab, as well as 24-monthy retention rates in this real-world study.  

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Effectiveness of Sequential Lines of Biologic and Targeted Small Molecule Drugs in Psoriatic Arthritis: A Systematic Review

Rheumatology (Oxford). 2024 Jan 18:keae006 doi: 10.1093/rheumatology/keae006 Epub ahead of print

The authors found that there is a reduction in effectiveness of lines of bDMARDs after first-line in PsA, with inadequate data to determine response to tsDMARDs.

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January 2024

Efficacy of Pharmacological Interventions: A Systematic Review Informing the 2023 EULAR Recommendations for the Management of Fatigue in People with Inflammatory Rheumatic and Musculoskeletal Diseases

RMD Open 2023;9(4):e003349 doi 10.1136/rmdopen-2023-003349

Adalimumab demonstrated superiority over placebo in reducing fatigue in RA at 12 and 52 weeks. Other interventions, which included golimumab, baricitinib, sarilumab, tocilizumab, and tofacitinib, also proved effective in reducing fatigue in patients with RA. Secukinumab also reduced fatigue by Week 52 in patients with SpA.

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2023 EULAR Recommendations for the Management of Fatigue in People with Inflammatory Rheumatic and Musculoskeletal Diseases

Ann Rheum Dis 2023 doi 10.1136/ard-2023-224514 Epub ahead of print

These recommendations from EULAR provide consensus and up-to-date guidance on fatigue management in people with I-RMDs, which includes advice regarding pharmacological and non-pharmacological interventions.

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Implementation of Regulatory Guidance for JAK Inhibitors Use in Patients with Immune-Mediated Inflammatory Diseases: An International Appropriateness Study

Autoimmun Rev. 2023;23(3):103504 doi: 10.1016/j.autrev.2023.103504 Epub ahead of print

In this two-round modified RAM study by Solitano, et al., the authors found that experts preferred to assess JAK inhibitor risk on a case-by-case basis across all specialties. Uncertainty remained on several clinical scenarios regarding the appropriate use of JAK inhibitors, however they remain an important therapy option for the treatment of IMIDs  and were deemed appropriate for patients with moderate risk profiles.

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The Effect of Two Years of Secukinumab Treatment on Bone Metabolism in Patients with Radiographic Axial Spondyloarthritis: Results from Daily Clinical Practice

Biologics 2023;17:161–166 doi: 10.2147/BTT.S434318

Siderius, et al. found that secukinumab was associated with low spinal radiographic progression. Furthermore, bone-related outcomes and BTMs related to collagen resorption (sCTX, PINP) remained constant during the 2-year period, whereas the BTM related to mineralisation (BALP) decreased significantly.

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