May 2022

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, 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.

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Drug survival of biologics and novel immunomodulators for rheumatoid arthritis, axial spondyloarthritis, psoriatic arthritis, and psoriasis – A nationwide cohort study from the DANBIO and DERMBIO registries

Semin Arthritis Rheum. 2022 doi: 10.1016/j.semarthrit.2022.151979

The authors reviewed drug survival of therapies across common inflammatory skin and joint conditions from national registries.  The findings highlighted that despite the overlapping pathogenesis of these conditions there was little similarity in drug survival. This reinforces the need for an individualised treatment approach consistent with the underlying disease, patient profile and treatment history.

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Treatment of axial spondyloarthritis: an update

Nat Rev Rheumatol. 18, 205–216 (2022) 2022 doi: 10.1038/s41584-022-00761-z

In this review Danve and Deodhar report an update on modern axSpa treatment. They found that in the past two decades substantial progress in the diagnosis and management of axSpA has been witnessed. Whilst ASAS classification criteria have enabled earlier diagnosis the increased availability of novel therapies, evolving drug safety data and novel clinical trials have allowed clinicians to rethink the placement and timing of drugs in disease management.

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April 2022

Achieving pain control in early rheumatoid arthritis with baricitinib monotherapy or in combination with methotrexate versus methotrexate monotherapy

RMD Open. 2022;8(1):e001994 doi: 10.1136/rmdopen-2021-001994

Post hoc analysis of the RA-BEGIN trial finds that, over a one-year period, patients treated with baricitinib (monotherapy or in combination with methotrexate [MTX]) report greater pain relief and a more rapid attainment of clinically meaningful thresholds of pain improvement, than patients who receive MTX monotherapy.Often overlooked, when treating RA solely to a disease activity target, patient-reported pain is common in RA, even in those reaching inflammatory remission. The fact that pain per...

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Evaluation of response to 13-valent conjugated pneumococcal vaccination in patients with rheumatoid arthritis receiving upadacitinib: results from a phase 2 open-label extension study

RMD Open. 2022;8(1):e002110 doi: 10.1136/rmdopen-2021-002110

Vaccine sub-study of the BALANCE-EXTEND upadacitinib trial finds that approximately two-thirds of patients receiving upadacitinib 15 mg once-daily achieve a satisfactory humoral response to pneumococcal 13-valent conjugate (PCV-13) vaccine, despite receiving concomitant methotrexate (MTX).It is well known that a weakened immune response, comorbidities and immunosuppressant drug therapy all contribute to an increased susceptibility to infections in patients with RA. Likewise, the morbidity and mo...

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March 2022

Baricitinib further enhances disease-modifying effects by uncoupling the link between disease activity and joint structural progression in patients with rheumatoid arthritis

Ann Rheum Dis. 2022. Epub ahead of print doi: 10.1136/annrheumdis-2021-221323

Baricitinib reduces structural damage progression versus placebo with background MTX and/or MTX, even in patients with moderate or high disease activity.In patients with RA, TNFi, IL-6i and rituximab have been shown to uncouple the link between disease activity and radiographic progression such that patients are protected from structural damage progression even if remission/low disease activity is not achieved.As such, Lopez-Romero, et al. aimed to evaluate if baricitinib further enhances diseas...

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Effectiveness of baricitinib and tofacitinib compared with bDMARDs in RA: results from a cohort study using nationwide Swedish register data

Rheumatology (Oxford). 2022. Epub ahead of print doi: 10.1093/rheumatology/keac068

Data from the Swedish Rheumatology Quality Register and Swedish Registries, show a higher treatment retention and overall equivalent or better treatment response on baricitinib, compared with bDMARDs or tofacitinib, but no statistically significant differences between tofacitinib and bDMARDs.In this largest population-based study to date, comparing RA patients initiating baricitinib, tofacitinib or bDMARDs, Barbulescu, et al. help to fill some of the current knowledge gaps surrounding the effica...

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February 2022

Janus kinase-targeting therapies in rheumatology: a mechanisms-based approach

Nat Rev Rheumatol. 2022 Jan 5:1–13. Epub ahead of print doi: 10.1038/s41584-021-00726-8

The development of targeted small-molecule therapies such as JAK inhibitors, which have varied selective inhibitory profiles, has enabled a paradigm shift in the treatment of diverse disorders, to the extent that they could ultimately enable either complete withdrawal or avoidance of glucocorticoid use in some autoimmune diseases, and could have the potential to regulate any active factor inhibiting the transition to cure.In this review paper, Tanaka, et al. describe the progress in JAK-targetin...

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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

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...

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Effect of JAK inhibitors on high- and low-density lipoprotein in patients with rheumatoid arthritis: a systematic review and network meta-analysis

Clin Rheumatol. 2022. Epub ahead of print doi: 10.1007/s10067-021-06003-z

Systematic review and network meta-analysis highlight that RA patients who receive recommended doses of the five approved JAK inhibitors (tofacitinib, baricitinib, upadacitinib, filgotinib, and peficitinib) are likely to experience an increase in serum low- and high-density lipoprotein (LDL and HDL) levels.JAK inhibitors have been associated with alterations in levels of LDL and HDL cholesterol, which may lead to dyslipidaemia (an important risk factor for cardiovascular disease). However, the e...

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