MDedge Rheumatology

Key clinical point: A greater proportion of patients with rheumatoid arthritis (RA) initially treated with oral baricitinib maintained lower levels of radiographic progression over 5 years than those initially treated with conventional synthetic disease-modifying antirheumatic drugs or placebo.

Major finding: At 5 years, no radiographic progression was achieved by a greater proportion of DMARD-naive patients with initial treatment with 4 mg baricitinib (59.0%) and initial treatment with 4 mg baricitinib + methotrexate (66.2%) vs. those with initial methotrexate treatment (40.7%). Similarly, a greater proportion of patients with inadequate response to methotrexate with initial baricitinib treatment (54.8%) or adalimumab treatment (55.0%) achieved no progression vs. those with initial placebo treatment (50.3%).

Study details: Findings are from a long-term extension RA-BEYOND trial, which included 2,125 patients with active adult-onset RA who completed any 1 of RA-BEGIN, RA-BEAM, or RA-BUILD phase 3 trials.

Disclosures: Eli Lilly and Company supported this study. The authors declared receiving grant/research support and consulting/speaker’s fees from various sources including Eli Lilly and Company. Three authors reported being current or former employees and shareholders of Eli Lilly.

Source: van der Heijde D et al. J Rheumatol. 2021 Sep 15. doi: 10.3899/jrheum.210346.

Key clinical point: A greater proportion of patients with rheumatoid arthritis (RA) initially treated with oral baricitinib maintained lower levels of radiographic progression over 5 years than those initially treated with conventional synthetic disease-modifying antirheumatic drugs or placebo.

Major finding: At 5 years, no radiographic progression was achieved by a greater proportion of DMARD-naive patients with initial treatment with 4 mg baricitinib (59.0%) and initial treatment with 4 mg baricitinib + methotrexate (66.2%) vs. those with initial methotrexate treatment (40.7%). Similarly, a greater proportion of patients with inadequate response to methotrexate with initial baricitinib treatment (54.8%) or adalimumab treatment (55.0%) achieved no progression vs. those with initial placebo treatment (50.3%).

Study details: Findings are from a long-term extension RA-BEYOND trial, which included 2,125 patients with active adult-onset RA who completed any 1 of RA-BEGIN, RA-BEAM, or RA-BUILD phase 3 trials.

Disclosures: Eli Lilly and Company supported this study. The authors declared receiving grant/research support and consulting/speaker’s fees from various sources including Eli Lilly and Company. Three authors reported being current or former employees and shareholders of Eli Lilly.

Source: van der Heijde D et al. J Rheumatol. 2021 Sep 15. doi: 10.3899/jrheum.210346.

Key clinical point: A greater proportion of patients with rheumatoid arthritis (RA) initially treated with oral baricitinib maintained lower levels of radiographic progression over 5 years than those initially treated with conventional synthetic disease-modifying antirheumatic drugs or placebo.

Major finding: At 5 years, no radiographic progression was achieved by a greater proportion of DMARD-naive patients with initial treatment with 4 mg baricitinib (59.0%) and initial treatment with 4 mg baricitinib + methotrexate (66.2%) vs. those with initial methotrexate treatment (40.7%). Similarly, a greater proportion of patients with inadequate response to methotrexate with initial baricitinib treatment (54.8%) or adalimumab treatment (55.0%) achieved no progression vs. those with initial placebo treatment (50.3%).

Study details: Findings are from a long-term extension RA-BEYOND trial, which included 2,125 patients with active adult-onset RA who completed any 1 of RA-BEGIN, RA-BEAM, or RA-BUILD phase 3 trials.

Disclosures: Eli Lilly and Company supported this study. The authors declared receiving grant/research support and consulting/speaker’s fees from various sources including Eli Lilly and Company. Three authors reported being current or former employees and shareholders of Eli Lilly.

Source: van der Heijde D et al. J Rheumatol. 2021 Sep 15. doi: 10.3899/jrheum.210346.

Key clinical point: Premenopausal women with rheumatoid arthritis (RA) had a significantly higher risk for diastolic dysfunction, and early screening may help prevent future cardiovascular events.

Major finding: Patients with RA had a significantly higher incidence of diastolic dysfunction (odds ratio [OR] 2.18; P = .020), with the risk being higher in women aged between 30 and 49 years vs. control participants of the same age (OR 3.54; 95% CI 1.27-9.85).

Study details: This study involved 61 premenopausal women with RA without any history of hypertension matched with 107 control participants.

Disclosures: No funding or financial conflict of interests was reported.

Source: Kim GH et al. Arthritis Res Ther. 2021 (Sep 24);23:247. doi: 10.1186/s13075-021-02629-1.

Key clinical point: Premenopausal women with rheumatoid arthritis (RA) had a significantly higher risk for diastolic dysfunction, and early screening may help prevent future cardiovascular events.

Major finding: Patients with RA had a significantly higher incidence of diastolic dysfunction (odds ratio [OR] 2.18; P = .020), with the risk being higher in women aged between 30 and 49 years vs. control participants of the same age (OR 3.54; 95% CI 1.27-9.85).

Study details: This study involved 61 premenopausal women with RA without any history of hypertension matched with 107 control participants.

Disclosures: No funding or financial conflict of interests was reported.

Source: Kim GH et al. Arthritis Res Ther. 2021 (Sep 24);23:247. doi: 10.1186/s13075-021-02629-1.

Key clinical point: Premenopausal women with rheumatoid arthritis (RA) had a significantly higher risk for diastolic dysfunction, and early screening may help prevent future cardiovascular events.

Major finding: Patients with RA had a significantly higher incidence of diastolic dysfunction (odds ratio [OR] 2.18; P = .020), with the risk being higher in women aged between 30 and 49 years vs. control participants of the same age (OR 3.54; 95% CI 1.27-9.85).

Study details: This study involved 61 premenopausal women with RA without any history of hypertension matched with 107 control participants.

Disclosures: No funding or financial conflict of interests was reported.

Source: Kim GH et al. Arthritis Res Ther. 2021 (Sep 24);23:247. doi: 10.1186/s13075-021-02629-1.

Key clinical point: Sarilumab monotherapy was as effective as its combination with methotrexate in patients with rheumatoid arthritis (RA). Hence, it could be a suitable alternative in patients with contraindications or intolerance to methotrexate.

Major finding: At 24 weeks, sarilumab vs. sarilumab + methotrexate groups had comparable least square mean change from baseline with overlapping confidence intervals for Clinical Disease Activity Index (−28.79 vs. −26.21), 28-joint Disease Activity using C-reactive protein (−2.95 vs. −2.81), and pain visual analog scale (−33.62 vs. −31.66).

Study details: This was a post hoc analysis of 184 patients with RA who received sarilumab in the MONARCH trial and 399 patients with RA with inadequate response to methotrexate, who received a combination of sarilumab and methotrexate in the MOBILITY trial.

Disclosures: Sanofi provided funding for this study. The authors including the lead author reported receiving grants/research support, consultancy, speaker’s fees, and consultancy fees or honoraria from various sources. A Praestgaard and HV Hoogstraten reported being employees of Sanofi and may hold stock or stock options in the company.

Source: Burmester GR et al. Rheumatology (Oxford). 2021 Sep 11. doi: 10.1093/rheumatology/keab676.

Key clinical point: Sarilumab monotherapy was as effective as its combination with methotrexate in patients with rheumatoid arthritis (RA). Hence, it could be a suitable alternative in patients with contraindications or intolerance to methotrexate.

Major finding: At 24 weeks, sarilumab vs. sarilumab + methotrexate groups had comparable least square mean change from baseline with overlapping confidence intervals for Clinical Disease Activity Index (−28.79 vs. −26.21), 28-joint Disease Activity using C-reactive protein (−2.95 vs. −2.81), and pain visual analog scale (−33.62 vs. −31.66).

Study details: This was a post hoc analysis of 184 patients with RA who received sarilumab in the MONARCH trial and 399 patients with RA with inadequate response to methotrexate, who received a combination of sarilumab and methotrexate in the MOBILITY trial.

Disclosures: Sanofi provided funding for this study. The authors including the lead author reported receiving grants/research support, consultancy, speaker’s fees, and consultancy fees or honoraria from various sources. A Praestgaard and HV Hoogstraten reported being employees of Sanofi and may hold stock or stock options in the company.

Source: Burmester GR et al. Rheumatology (Oxford). 2021 Sep 11. doi: 10.1093/rheumatology/keab676.

Key clinical point: Sarilumab monotherapy was as effective as its combination with methotrexate in patients with rheumatoid arthritis (RA). Hence, it could be a suitable alternative in patients with contraindications or intolerance to methotrexate.

Major finding: At 24 weeks, sarilumab vs. sarilumab + methotrexate groups had comparable least square mean change from baseline with overlapping confidence intervals for Clinical Disease Activity Index (−28.79 vs. −26.21), 28-joint Disease Activity using C-reactive protein (−2.95 vs. −2.81), and pain visual analog scale (−33.62 vs. −31.66).

Study details: This was a post hoc analysis of 184 patients with RA who received sarilumab in the MONARCH trial and 399 patients with RA with inadequate response to methotrexate, who received a combination of sarilumab and methotrexate in the MOBILITY trial.

Disclosures: Sanofi provided funding for this study. The authors including the lead author reported receiving grants/research support, consultancy, speaker’s fees, and consultancy fees or honoraria from various sources. A Praestgaard and HV Hoogstraten reported being employees of Sanofi and may hold stock or stock options in the company.

Source: Burmester GR et al. Rheumatology (Oxford). 2021 Sep 11. doi: 10.1093/rheumatology/keab676.

Key clinical point: Exposure to biologic disease-modifying antirheumatic drugs (bDMARD) did not seem to be associated with an elevated risk for recurrent or new cancer in patients with rheumatoid arthritis (RA) and a history of cancer.

Major finding: The risk for recurrent or new cancer was not significantly higher in patients with RA receiving bDMARDs (relative risk [RR], 1.09; P = .31), tumor necrosis factor inhibitors (RR 1.11; P = .45), or rituximab (RR 0.79; P = .49) vs. those not receiving bDMARDs.

Study details: This was a meta-analysis of 12 observational studies involving patients with RA who had a history of cancer and received bDMARDs.

Disclosures: No specific funding was received for this study. The authors declared receiving honoraria or grants from various sources.

Source: Wetzman A et al. Arthritis Care Res (Hoboken). 2021 Sep 21. doi: 10.1002/acr.24784.

Key clinical point: Exposure to biologic disease-modifying antirheumatic drugs (bDMARD) did not seem to be associated with an elevated risk for recurrent or new cancer in patients with rheumatoid arthritis (RA) and a history of cancer.

Major finding: The risk for recurrent or new cancer was not significantly higher in patients with RA receiving bDMARDs (relative risk [RR], 1.09; P = .31), tumor necrosis factor inhibitors (RR 1.11; P = .45), or rituximab (RR 0.79; P = .49) vs. those not receiving bDMARDs.

Study details: This was a meta-analysis of 12 observational studies involving patients with RA who had a history of cancer and received bDMARDs.

Disclosures: No specific funding was received for this study. The authors declared receiving honoraria or grants from various sources.

Source: Wetzman A et al. Arthritis Care Res (Hoboken). 2021 Sep 21. doi: 10.1002/acr.24784.

Key clinical point: Exposure to biologic disease-modifying antirheumatic drugs (bDMARD) did not seem to be associated with an elevated risk for recurrent or new cancer in patients with rheumatoid arthritis (RA) and a history of cancer.

Major finding: The risk for recurrent or new cancer was not significantly higher in patients with RA receiving bDMARDs (relative risk [RR], 1.09; P = .31), tumor necrosis factor inhibitors (RR 1.11; P = .45), or rituximab (RR 0.79; P = .49) vs. those not receiving bDMARDs.

Study details: This was a meta-analysis of 12 observational studies involving patients with RA who had a history of cancer and received bDMARDs.

Disclosures: No specific funding was received for this study. The authors declared receiving honoraria or grants from various sources.

Source: Wetzman A et al. Arthritis Care Res (Hoboken). 2021 Sep 21. doi: 10.1002/acr.24784.

Key clinical point: Discontinuation of denosumab after 1 year of treatment showed a return to baseline lumbar spine (LS) and total hip (TH) bone mineral density (BMD) in patients with rheumatoid arthritis (RA) receiving glucocorticoids.

Major finding: By 12 months after discontinuation, TH BMD reduced to levels similar to or slightly above placebo in patients receiving 60 mg (P = .210) and 180 mg denosumab (P = .706). Similar reversal of gains was observed for LS BMD with the least-square percent mean change from baseline in placebo, 60 mg, and 180 mg denosumab, being 2.30% (95% CI −0.35%-4.94%), 1.31% (95% CI −1.17%-3.79%), and 0.12% (95% CI −2.45%-2.68%), respectively.

Study details: This was a post hoc analysis of a phase 2 study including 82 patients with RA receiving glucocorticoids, randomly assigned to placebo, 60 mg, or 180 mg denosumab every 6 months for 12 months.

Disclosures: The study was sponsored by Amgen Inc. Some of the authors declared ties with various sources including Amgen. MT McDermott, RK Stad, L Chen, and S Huang declared being employees of Amgen.

Source: Saag KG et al. Arthritis Rheumatol. 2021 Sep 17. doi: 10.1002/art.41981.

Key clinical point: Discontinuation of denosumab after 1 year of treatment showed a return to baseline lumbar spine (LS) and total hip (TH) bone mineral density (BMD) in patients with rheumatoid arthritis (RA) receiving glucocorticoids.

Major finding: By 12 months after discontinuation, TH BMD reduced to levels similar to or slightly above placebo in patients receiving 60 mg (P = .210) and 180 mg denosumab (P = .706). Similar reversal of gains was observed for LS BMD with the least-square percent mean change from baseline in placebo, 60 mg, and 180 mg denosumab, being 2.30% (95% CI −0.35%-4.94%), 1.31% (95% CI −1.17%-3.79%), and 0.12% (95% CI −2.45%-2.68%), respectively.

Study details: This was a post hoc analysis of a phase 2 study including 82 patients with RA receiving glucocorticoids, randomly assigned to placebo, 60 mg, or 180 mg denosumab every 6 months for 12 months.

Disclosures: The study was sponsored by Amgen Inc. Some of the authors declared ties with various sources including Amgen. MT McDermott, RK Stad, L Chen, and S Huang declared being employees of Amgen.

Source: Saag KG et al. Arthritis Rheumatol. 2021 Sep 17. doi: 10.1002/art.41981.

Key clinical point: Discontinuation of denosumab after 1 year of treatment showed a return to baseline lumbar spine (LS) and total hip (TH) bone mineral density (BMD) in patients with rheumatoid arthritis (RA) receiving glucocorticoids.

Major finding: By 12 months after discontinuation, TH BMD reduced to levels similar to or slightly above placebo in patients receiving 60 mg (P = .210) and 180 mg denosumab (P = .706). Similar reversal of gains was observed for LS BMD with the least-square percent mean change from baseline in placebo, 60 mg, and 180 mg denosumab, being 2.30% (95% CI −0.35%-4.94%), 1.31% (95% CI −1.17%-3.79%), and 0.12% (95% CI −2.45%-2.68%), respectively.

Study details: This was a post hoc analysis of a phase 2 study including 82 patients with RA receiving glucocorticoids, randomly assigned to placebo, 60 mg, or 180 mg denosumab every 6 months for 12 months.

Disclosures: The study was sponsored by Amgen Inc. Some of the authors declared ties with various sources including Amgen. MT McDermott, RK Stad, L Chen, and S Huang declared being employees of Amgen.

Source: Saag KG et al. Arthritis Rheumatol. 2021 Sep 17. doi: 10.1002/art.41981.

Key clinical point: Despite higher initial disease activity, patients with rheumatoid arthritis (RA) who received biologic disease-modifying antirheumatic drugs (bDMARDs) vs. conventional synthetic DMARDs (csDMARDs) had a lower incidence of total knee replacement (TKR) and total hip replacement (THR).

Major finding: The incidence of TKR (incidence rate ratio [IRR] 0.72; 95% CI 0.62-0.83) and THR (IRR 0.77; 95% CI 0.64-0.93) was significantly lower in patients receiving biologics vs. those who received csDMARDs, with TKR (adjusted hazard ratio [aHR] 0.55; 95% CI 0.38-0.81) and THR (aHR 0.63; 95% CI 0.40-0.98) risk being lowest in patients with regular bDMARD use.

Study details: This was a nationwide retrospective study involving 48,165 patients with RA. Patients receiving biologics without undergoing TKR (n = 5,979) or THR (n = 6,245) formed the biologic cohort matched with control cohorts comprising 11,958 and 12,490 patients receiving csDMARDs, respectively.

Disclosures: No specific funding or conflict of interests was reported.

Source: Chang YS et al. Rheumatology (Oxford). 2021 Sep 17. doi: 10.1093/rheumatology/keab671.

Key clinical point: Despite higher initial disease activity, patients with rheumatoid arthritis (RA) who received biologic disease-modifying antirheumatic drugs (bDMARDs) vs. conventional synthetic DMARDs (csDMARDs) had a lower incidence of total knee replacement (TKR) and total hip replacement (THR).

Major finding: The incidence of TKR (incidence rate ratio [IRR] 0.72; 95% CI 0.62-0.83) and THR (IRR 0.77; 95% CI 0.64-0.93) was significantly lower in patients receiving biologics vs. those who received csDMARDs, with TKR (adjusted hazard ratio [aHR] 0.55; 95% CI 0.38-0.81) and THR (aHR 0.63; 95% CI 0.40-0.98) risk being lowest in patients with regular bDMARD use.

Study details: This was a nationwide retrospective study involving 48,165 patients with RA. Patients receiving biologics without undergoing TKR (n = 5,979) or THR (n = 6,245) formed the biologic cohort matched with control cohorts comprising 11,958 and 12,490 patients receiving csDMARDs, respectively.

Disclosures: No specific funding or conflict of interests was reported.

Source: Chang YS et al. Rheumatology (Oxford). 2021 Sep 17. doi: 10.1093/rheumatology/keab671.

Key clinical point: Despite higher initial disease activity, patients with rheumatoid arthritis (RA) who received biologic disease-modifying antirheumatic drugs (bDMARDs) vs. conventional synthetic DMARDs (csDMARDs) had a lower incidence of total knee replacement (TKR) and total hip replacement (THR).

Major finding: The incidence of TKR (incidence rate ratio [IRR] 0.72; 95% CI 0.62-0.83) and THR (IRR 0.77; 95% CI 0.64-0.93) was significantly lower in patients receiving biologics vs. those who received csDMARDs, with TKR (adjusted hazard ratio [aHR] 0.55; 95% CI 0.38-0.81) and THR (aHR 0.63; 95% CI 0.40-0.98) risk being lowest in patients with regular bDMARD use.

Study details: This was a nationwide retrospective study involving 48,165 patients with RA. Patients receiving biologics without undergoing TKR (n = 5,979) or THR (n = 6,245) formed the biologic cohort matched with control cohorts comprising 11,958 and 12,490 patients receiving csDMARDs, respectively.

Disclosures: No specific funding or conflict of interests was reported.

Source: Chang YS et al. Rheumatology (Oxford). 2021 Sep 17. doi: 10.1093/rheumatology/keab671.

Key clinical point: After adjustment for hyperlipidemia, the risk of developing rheumatoid arthritis (RA) was not higher among statin users than nonusers.

Major finding: After adjusting for hyperlipidemia, the risk of developing RA was not higher among former users of statins (adjusted odds ratio [aOR] 1.03; 95% CI 0.96-1.10) and was slightly lower among current users (aOR 0.87; 95% CI 0.81-0.93) than nonusers.

Study details: This was a nationwide case-control study of 16,363 patients with RA and a similar number of matched control participants.

Disclosures: The National Institutes of Health, the National Institute of Arthritis and Musculoskeletal and Skin Diseases, and the National Institute on Aging funded this work. None of the authors declared any conflict of interest.

Source: Peterson MN et al. Arthritis Res Ther. 2021 (Sep 18):23:244. doi: 10.1186/s13075-021-02617-5.

Key clinical point: After adjustment for hyperlipidemia, the risk of developing rheumatoid arthritis (RA) was not higher among statin users than nonusers.

Major finding: After adjusting for hyperlipidemia, the risk of developing RA was not higher among former users of statins (adjusted odds ratio [aOR] 1.03; 95% CI 0.96-1.10) and was slightly lower among current users (aOR 0.87; 95% CI 0.81-0.93) than nonusers.

Study details: This was a nationwide case-control study of 16,363 patients with RA and a similar number of matched control participants.

Disclosures: The National Institutes of Health, the National Institute of Arthritis and Musculoskeletal and Skin Diseases, and the National Institute on Aging funded this work. None of the authors declared any conflict of interest.

Source: Peterson MN et al. Arthritis Res Ther. 2021 (Sep 18):23:244. doi: 10.1186/s13075-021-02617-5.

Key clinical point: After adjustment for hyperlipidemia, the risk of developing rheumatoid arthritis (RA) was not higher among statin users than nonusers.

Major finding: After adjusting for hyperlipidemia, the risk of developing RA was not higher among former users of statins (adjusted odds ratio [aOR] 1.03; 95% CI 0.96-1.10) and was slightly lower among current users (aOR 0.87; 95% CI 0.81-0.93) than nonusers.

Study details: This was a nationwide case-control study of 16,363 patients with RA and a similar number of matched control participants.

Disclosures: The National Institutes of Health, the National Institute of Arthritis and Musculoskeletal and Skin Diseases, and the National Institute on Aging funded this work. None of the authors declared any conflict of interest.

Source: Peterson MN et al. Arthritis Res Ther. 2021 (Sep 18):23:244. doi: 10.1186/s13075-021-02617-5.

Key clinical point: A switch from adalimumab (ADL), sourced from the European Union (ADL-EU), to ADL biosimilar PF-06410293 (ADL-PF) had no effect on long-term treatment efficacy and safety in patients with active rheumatoid arthritis (RA).

Major finding: The American College of Rheumatology 20 response rate was sustained and similar in patients maintained on ADL-PF and those who switched from ADL-EU to ADL-PF at weeks 26 and 52 (52 weeks: 88.4%, 88.2%, and 87.6%, respectively; 78 weeks: 83.4%, 85.8%, and 84.3%, respectively). From weeks 52-78, the incidence of treatment-related adverse events was 42.6%, 37.0%, and 50.8% for the biosimilar, week 26 switch, and week 52 switch groups, respectively.

Study details: Findings are from an analysis of 597 patients with RA and an inadequate response to methotrexate who continued ADL-PF treatment throughout 78 weeks or switched from ADL-EU to ADL-PF at week 26 or 52 in the phase 3 REFLECTIONS B538-02 trial.

Disclosures: The study was sponsored by Pfizer. Five authors reported being employees and shareholders of Pfizer, and two reported receiving grants/support and consulting fees from several sources.

Source: Fleischmann RM. Arthritis Res Ther. 2021(Sep 25);23:248. doi: 10.1186/s13075-021-02626-4.

Key clinical point: A switch from adalimumab (ADL), sourced from the European Union (ADL-EU), to ADL biosimilar PF-06410293 (ADL-PF) had no effect on long-term treatment efficacy and safety in patients with active rheumatoid arthritis (RA).

Major finding: The American College of Rheumatology 20 response rate was sustained and similar in patients maintained on ADL-PF and those who switched from ADL-EU to ADL-PF at weeks 26 and 52 (52 weeks: 88.4%, 88.2%, and 87.6%, respectively; 78 weeks: 83.4%, 85.8%, and 84.3%, respectively). From weeks 52-78, the incidence of treatment-related adverse events was 42.6%, 37.0%, and 50.8% for the biosimilar, week 26 switch, and week 52 switch groups, respectively.

Study details: Findings are from an analysis of 597 patients with RA and an inadequate response to methotrexate who continued ADL-PF treatment throughout 78 weeks or switched from ADL-EU to ADL-PF at week 26 or 52 in the phase 3 REFLECTIONS B538-02 trial.

Disclosures: The study was sponsored by Pfizer. Five authors reported being employees and shareholders of Pfizer, and two reported receiving grants/support and consulting fees from several sources.

Source: Fleischmann RM. Arthritis Res Ther. 2021(Sep 25);23:248. doi: 10.1186/s13075-021-02626-4.

Key clinical point: A switch from adalimumab (ADL), sourced from the European Union (ADL-EU), to ADL biosimilar PF-06410293 (ADL-PF) had no effect on long-term treatment efficacy and safety in patients with active rheumatoid arthritis (RA).

Major finding: The American College of Rheumatology 20 response rate was sustained and similar in patients maintained on ADL-PF and those who switched from ADL-EU to ADL-PF at weeks 26 and 52 (52 weeks: 88.4%, 88.2%, and 87.6%, respectively; 78 weeks: 83.4%, 85.8%, and 84.3%, respectively). From weeks 52-78, the incidence of treatment-related adverse events was 42.6%, 37.0%, and 50.8% for the biosimilar, week 26 switch, and week 52 switch groups, respectively.

Study details: Findings are from an analysis of 597 patients with RA and an inadequate response to methotrexate who continued ADL-PF treatment throughout 78 weeks or switched from ADL-EU to ADL-PF at week 26 or 52 in the phase 3 REFLECTIONS B538-02 trial.

Disclosures: The study was sponsored by Pfizer. Five authors reported being employees and shareholders of Pfizer, and two reported receiving grants/support and consulting fees from several sources.

Source: Fleischmann RM. Arthritis Res Ther. 2021(Sep 25);23:248. doi: 10.1186/s13075-021-02626-4.

Key clinical point: The prevalence of low lean mass and sarcopenic obesity was significantly higher in patients with rheumatoid arthritis (RA) than the general reference population.

Major finding: Patients with RA compared to reference populations from NHANES and HealthABC had a greater prevalence of low lean mass (14.2% vs. 10.0% and 7.0%, respectively; all P < .001) and sarcopenic obesity (12.6% vs. 4.5% and 4.0%, respectively; all P < .001), with both associated with worse Health Assessment Questionnaire scores, suggesting worse disability (P < .001).

Study details: The findings came from the analysis of 113, 190, and 141 patients with RA from the University of Pennsylvania, Events in RA study, and University of San Francisco cohorts, respectively, compared with reference populations from NHANES and HealthABC.

Disclosures: This work was supported by a VA Clinical Science Research and Development Award, the National Institutes of Health, the University of Pennsylvania Clinical and Translational Research Center, among others. JF Bater declared receiving consulting fees from Bristol Myers Squibb, Gilead, and Pfizer.

Source: Baker JF et al. Rheumatology (Oxford). 2021 Sep 24. doi: 10.1093/rheumatology/keab710.

Key clinical point: The prevalence of low lean mass and sarcopenic obesity was significantly higher in patients with rheumatoid arthritis (RA) than the general reference population.

Major finding: Patients with RA compared to reference populations from NHANES and HealthABC had a greater prevalence of low lean mass (14.2% vs. 10.0% and 7.0%, respectively; all P < .001) and sarcopenic obesity (12.6% vs. 4.5% and 4.0%, respectively; all P < .001), with both associated with worse Health Assessment Questionnaire scores, suggesting worse disability (P < .001).

Study details: The findings came from the analysis of 113, 190, and 141 patients with RA from the University of Pennsylvania, Events in RA study, and University of San Francisco cohorts, respectively, compared with reference populations from NHANES and HealthABC.

Disclosures: This work was supported by a VA Clinical Science Research and Development Award, the National Institutes of Health, the University of Pennsylvania Clinical and Translational Research Center, among others. JF Bater declared receiving consulting fees from Bristol Myers Squibb, Gilead, and Pfizer.

Source: Baker JF et al. Rheumatology (Oxford). 2021 Sep 24. doi: 10.1093/rheumatology/keab710.

Key clinical point: The prevalence of low lean mass and sarcopenic obesity was significantly higher in patients with rheumatoid arthritis (RA) than the general reference population.

Major finding: Patients with RA compared to reference populations from NHANES and HealthABC had a greater prevalence of low lean mass (14.2% vs. 10.0% and 7.0%, respectively; all P < .001) and sarcopenic obesity (12.6% vs. 4.5% and 4.0%, respectively; all P < .001), with both associated with worse Health Assessment Questionnaire scores, suggesting worse disability (P < .001).

Study details: The findings came from the analysis of 113, 190, and 141 patients with RA from the University of Pennsylvania, Events in RA study, and University of San Francisco cohorts, respectively, compared with reference populations from NHANES and HealthABC.

Disclosures: This work was supported by a VA Clinical Science Research and Development Award, the National Institutes of Health, the University of Pennsylvania Clinical and Translational Research Center, among others. JF Bater declared receiving consulting fees from Bristol Myers Squibb, Gilead, and Pfizer.

Source: Baker JF et al. Rheumatology (Oxford). 2021 Sep 24. doi: 10.1093/rheumatology/keab710.

Among patients with immune-mediated inflammatory diseases (IMIDs) who get COVID-19, the risk for hospitalization and death is lower if they are receiving tumor necrosis factor (TNF) inhibitor monotherapy, compared with receiving most other common drugs for these conditions, with or without TNF inhibitors, according to a study published in JAMA Network Open The only combination not associated with an increased risk for hospitalization or death was TNF inhibitor therapy with methotrexate.

“These findings support the continued use of TNF inhibitor monotherapy during the pandemic and warrant further research investigating the association of other biologic therapies with COVID-19 outcomes,” write Zara Izadi, MPharm, of the University of California, San Francisco, and her colleagues. “Treatment with TNF inhibitor combination therapy was associated with a more favorable safety profile when methotrexate rather than azathioprine/6-mercaptopurine was used, suggesting that clinicians would benefit from weighing the risks versus benefits of deescalating treatment or changing medications when a patient is receiving concomitant TNF inhibitors and azathioprine/6-mercaptopurine,” they write.
 

Findings mirror those seen in other settings

These findings are in line with what has been found in other settings, according to Joel M. Gelfand, MD, director of the psoriasis and phototherapy treatment center, vice chair of clinical research, and medical director of the dermatology clinical studies unit at the University of Pennsylvania, Philadelphia.

“In the beginning of the pandemic, there was concern about use of immune-modulating treatments, and many patients self-discontinued treatments like TNF inhibitors,” Dr. Gelfand, who was not involved in the study, told this news organization. “This has ultimately proved unnecessary and unfortunately resulted in harm to many patients due to flaring of their underlying disease.”

Dr. Gelfand emphasized the importance of vaccinating patients against COVID-19 as soon as possible and of getting a third dose for those who are already fully vaccinated with the Pfizer or Moderna shots, as recommended by the Centers for Disease Control and Prevention.

“I typically recommend this third dose be taken 6 months after the second dose,” Dr. Gelfand said. “The good news is that TNF inhibitors do not seem to meaningfully impact response to mRNA vaccines.”
 

Study details

The researchers analyzed data from three international registries of adults with rheumatic diseases, inflammatory bowel disease, and psoriasis who had COVID-19 between March 12, 2020, and Feb. 1, 2021. The registries included the Secure Epidemiology of Coronavirus Under Research Exclusion for Inflammatory Bowel Disease (SECURE-IBD) registry, the Psoriasis Patient Registry for Outcomes, Therapy and Epidemiology of COVID-19 Infection (PsoProtect), and the physician-reported registry from the Global Rheumatology Alliance (GRA).

The population included 6,077 patients from 74 countries. About half of the cohort (52.9%) were from Europe; more than half were women (58.6%). The average age was 48 years. A little over one-third of the patients (35.3%) had rheumatoid arthritis, 25.3% had Crohn’s disease, 12.5% had ulcerative colitis, 10.3% had spondyloarthritis, and 9.3% had psoriatic arthritis. Smaller percentages had psoriasis (4.9%), another type of arthritis or multiple types (1.7%), or another inflammatory bowel disease (0.6%).

One in five patients (21.3%) were hospitalized, and 3.1% died. The researchers compared outcomes for those who were receiving TNF inhibitor therapy alone to outcomes for those who were taking azathioprine/6-mercaptopurine therapy (alone or with a TNF inhibitor), methotrexate (alone or with a TNF inhibitor), and Janus kinase (JAK) inhibitors. They adjusted their analysis to account for active disease and common comorbidities, as well as geography and the period during the pandemic in which the person was admitted, because treatment regimens and hospitalization indications have varied over time.

All of the therapies except the combination of TNF inhibitors and methotrexate were associated with higher odds of hospitalization and death than TNF inhibitor monotherapy.

The researchers explored several possible explanations for the findings, including the possibility that high serum TNF concentrations may have been associated with more organ damage at the time of COVID-19 admission, owing to interaction with SARS-CoV-2–associated hyperinflammation.

“Therefore, blocking TNF could inhibit this detrimental immune response,” the authors write. “Multiple case series reporting favorable outcomes among patients receiving TNF inhibitor therapy support this assertion.”

Another possibility relates to the effects of taking non–TNF inhibitor medications for immunosuppression. The authors note that thiopurine medications are linked to a greater risk for opportunistic viral infections and that JAK inhibitors may reduce the body’s ability to clear the virus because of its suppression of innate immune response.

The authors also postulate that methotrexate may lower the likelihood of cytokine storm linked to COVID-19, even though methotrexate monotherapy was associated with poorer outcomes. “This association could mean that TNF inhibitor therapy is exerting a protective benefit or that methotrexate therapy is exerting a harmful consequence,” the authors write.

 

Caution needed in interpreting uncontrolled, registry-based data

The findings were not surprising to Stephen B. Hanauer, MD, medical director of the Digestive Health Center at Northwestern University, Chicago, who was not involved in the research.

Northwestern University

“We’ve been monitoring IBD [inflammatory bowel disease] patients through the Secure registry similar to the rheumatologic and dermatologic societies and have not identified a signal of harm from any international groups,” Dr. Hanauer told this news organization. He noted that these registries also have not shown an increased risk for COVID-19 complications among patients receiving TNF inhibitors, antiadhesion therapies, or anti–IL12/23 inhibitors, compared with the general population not taking these therapies.

The study’s size and the diversity of patients strengthen its findings. However, the registries’ use of convenience sampling increases the potential for reporting bias, although the results remained similar after a sensitivity analysis. The study also lacked a control group, and the registries did not collect data uniformly.

“These are databases that rely on reporting from investigators and are not comprehensive prospective studies,” Dr. Hanauer noted as another study limitation.

Dr. Gelfand similarly advised caution in interpreting these findings, inasmuch as the study is a “collection of spontaneous reports” that should be viewed as hypothesis-generating rather than testing.

“Fortunately, more rigorous studies have been conducted, typically in large medical record systems, and have confirmed the hypothesis that TNF inhibitors are associated with a lower risk of poor COVID-19 outcomes, compared to other treatments,” Dr. Gelfand said.

Previous smaller studies similarly found better outcomes among patients taking TNF inhibitors, compared with other therapies, but their participants were predominantly from North America and Europe, noted Licio A. Velloso, MD, PhD, of the University of Campinas, in São Paulo, in an accompanying commentary.

On the basis of the findings of this study, “which included a much larger sample comprising distinct diseases and patients with a multitude of genetic backgrounds, the evidence in favor of the continued use of TNF inhibitor monotherapy for patients with IMIDs during the COVID-19 pandemic has become more substantial,” Dr. Velloso writes. “The finding that maintenance of TNF inhibitor monotherapy is associated with reductions in the risk of severe COVID-19 among patients with IMIDs offers new perspective that may guide health care professionals in the difficult decisions regarding therapeutic approaches among this specific group of patients.”

The research was funded by the American College of Rheumatology, the European Alliance of Associations for Rheumatology, the United Kingdom’s National Institute for Health Research Biomedical Research Center, and the Psoriasis Association. Many authors reported receiving grants and/or personal fees from a variety of pharmaceutical companies. Dr. Velloso has disclosed no relevant financial relationships. Dr. Hanauer has served as a consultant to companies that market TNF inhibitors. Dr. Gelfand has consulted for and received research grants from companies that market TNF inhibitors.

A version of this article first appeared on Medscape.com.

Among patients with immune-mediated inflammatory diseases (IMIDs) who get COVID-19, the risk for hospitalization and death is lower if they are receiving tumor necrosis factor (TNF) inhibitor monotherapy, compared with receiving most other common drugs for these conditions, with or without TNF inhibitors, according to a study published in JAMA Network Open The only combination not associated with an increased risk for hospitalization or death was TNF inhibitor therapy with methotrexate.

“These findings support the continued use of TNF inhibitor monotherapy during the pandemic and warrant further research investigating the association of other biologic therapies with COVID-19 outcomes,” write Zara Izadi, MPharm, of the University of California, San Francisco, and her colleagues. “Treatment with TNF inhibitor combination therapy was associated with a more favorable safety profile when methotrexate rather than azathioprine/6-mercaptopurine was used, suggesting that clinicians would benefit from weighing the risks versus benefits of deescalating treatment or changing medications when a patient is receiving concomitant TNF inhibitors and azathioprine/6-mercaptopurine,” they write.
 

Findings mirror those seen in other settings

These findings are in line with what has been found in other settings, according to Joel M. Gelfand, MD, director of the psoriasis and phototherapy treatment center, vice chair of clinical research, and medical director of the dermatology clinical studies unit at the University of Pennsylvania, Philadelphia.

“In the beginning of the pandemic, there was concern about use of immune-modulating treatments, and many patients self-discontinued treatments like TNF inhibitors,” Dr. Gelfand, who was not involved in the study, told this news organization. “This has ultimately proved unnecessary and unfortunately resulted in harm to many patients due to flaring of their underlying disease.”

Dr. Gelfand emphasized the importance of vaccinating patients against COVID-19 as soon as possible and of getting a third dose for those who are already fully vaccinated with the Pfizer or Moderna shots, as recommended by the Centers for Disease Control and Prevention.

“I typically recommend this third dose be taken 6 months after the second dose,” Dr. Gelfand said. “The good news is that TNF inhibitors do not seem to meaningfully impact response to mRNA vaccines.”
 

Study details

The researchers analyzed data from three international registries of adults with rheumatic diseases, inflammatory bowel disease, and psoriasis who had COVID-19 between March 12, 2020, and Feb. 1, 2021. The registries included the Secure Epidemiology of Coronavirus Under Research Exclusion for Inflammatory Bowel Disease (SECURE-IBD) registry, the Psoriasis Patient Registry for Outcomes, Therapy and Epidemiology of COVID-19 Infection (PsoProtect), and the physician-reported registry from the Global Rheumatology Alliance (GRA).

The population included 6,077 patients from 74 countries. About half of the cohort (52.9%) were from Europe; more than half were women (58.6%). The average age was 48 years. A little over one-third of the patients (35.3%) had rheumatoid arthritis, 25.3% had Crohn’s disease, 12.5% had ulcerative colitis, 10.3% had spondyloarthritis, and 9.3% had psoriatic arthritis. Smaller percentages had psoriasis (4.9%), another type of arthritis or multiple types (1.7%), or another inflammatory bowel disease (0.6%).

One in five patients (21.3%) were hospitalized, and 3.1% died. The researchers compared outcomes for those who were receiving TNF inhibitor therapy alone to outcomes for those who were taking azathioprine/6-mercaptopurine therapy (alone or with a TNF inhibitor), methotrexate (alone or with a TNF inhibitor), and Janus kinase (JAK) inhibitors. They adjusted their analysis to account for active disease and common comorbidities, as well as geography and the period during the pandemic in which the person was admitted, because treatment regimens and hospitalization indications have varied over time.

All of the therapies except the combination of TNF inhibitors and methotrexate were associated with higher odds of hospitalization and death than TNF inhibitor monotherapy.

The researchers explored several possible explanations for the findings, including the possibility that high serum TNF concentrations may have been associated with more organ damage at the time of COVID-19 admission, owing to interaction with SARS-CoV-2–associated hyperinflammation.

“Therefore, blocking TNF could inhibit this detrimental immune response,” the authors write. “Multiple case series reporting favorable outcomes among patients receiving TNF inhibitor therapy support this assertion.”

Another possibility relates to the effects of taking non–TNF inhibitor medications for immunosuppression. The authors note that thiopurine medications are linked to a greater risk for opportunistic viral infections and that JAK inhibitors may reduce the body’s ability to clear the virus because of its suppression of innate immune response.

The authors also postulate that methotrexate may lower the likelihood of cytokine storm linked to COVID-19, even though methotrexate monotherapy was associated with poorer outcomes. “This association could mean that TNF inhibitor therapy is exerting a protective benefit or that methotrexate therapy is exerting a harmful consequence,” the authors write.

 

Caution needed in interpreting uncontrolled, registry-based data

The findings were not surprising to Stephen B. Hanauer, MD, medical director of the Digestive Health Center at Northwestern University, Chicago, who was not involved in the research.

Northwestern University

“We’ve been monitoring IBD [inflammatory bowel disease] patients through the Secure registry similar to the rheumatologic and dermatologic societies and have not identified a signal of harm from any international groups,” Dr. Hanauer told this news organization. He noted that these registries also have not shown an increased risk for COVID-19 complications among patients receiving TNF inhibitors, antiadhesion therapies, or anti–IL12/23 inhibitors, compared with the general population not taking these therapies.

The study’s size and the diversity of patients strengthen its findings. However, the registries’ use of convenience sampling increases the potential for reporting bias, although the results remained similar after a sensitivity analysis. The study also lacked a control group, and the registries did not collect data uniformly.

“These are databases that rely on reporting from investigators and are not comprehensive prospective studies,” Dr. Hanauer noted as another study limitation.

Dr. Gelfand similarly advised caution in interpreting these findings, inasmuch as the study is a “collection of spontaneous reports” that should be viewed as hypothesis-generating rather than testing.

“Fortunately, more rigorous studies have been conducted, typically in large medical record systems, and have confirmed the hypothesis that TNF inhibitors are associated with a lower risk of poor COVID-19 outcomes, compared to other treatments,” Dr. Gelfand said.

Previous smaller studies similarly found better outcomes among patients taking TNF inhibitors, compared with other therapies, but their participants were predominantly from North America and Europe, noted Licio A. Velloso, MD, PhD, of the University of Campinas, in São Paulo, in an accompanying commentary.

On the basis of the findings of this study, “which included a much larger sample comprising distinct diseases and patients with a multitude of genetic backgrounds, the evidence in favor of the continued use of TNF inhibitor monotherapy for patients with IMIDs during the COVID-19 pandemic has become more substantial,” Dr. Velloso writes. “The finding that maintenance of TNF inhibitor monotherapy is associated with reductions in the risk of severe COVID-19 among patients with IMIDs offers new perspective that may guide health care professionals in the difficult decisions regarding therapeutic approaches among this specific group of patients.”

The research was funded by the American College of Rheumatology, the European Alliance of Associations for Rheumatology, the United Kingdom’s National Institute for Health Research Biomedical Research Center, and the Psoriasis Association. Many authors reported receiving grants and/or personal fees from a variety of pharmaceutical companies. Dr. Velloso has disclosed no relevant financial relationships. Dr. Hanauer has served as a consultant to companies that market TNF inhibitors. Dr. Gelfand has consulted for and received research grants from companies that market TNF inhibitors.

A version of this article first appeared on Medscape.com.

Among patients with immune-mediated inflammatory diseases (IMIDs) who get COVID-19, the risk for hospitalization and death is lower if they are receiving tumor necrosis factor (TNF) inhibitor monotherapy, compared with receiving most other common drugs for these conditions, with or without TNF inhibitors, according to a study published in JAMA Network Open The only combination not associated with an increased risk for hospitalization or death was TNF inhibitor therapy with methotrexate.

“These findings support the continued use of TNF inhibitor monotherapy during the pandemic and warrant further research investigating the association of other biologic therapies with COVID-19 outcomes,” write Zara Izadi, MPharm, of the University of California, San Francisco, and her colleagues. “Treatment with TNF inhibitor combination therapy was associated with a more favorable safety profile when methotrexate rather than azathioprine/6-mercaptopurine was used, suggesting that clinicians would benefit from weighing the risks versus benefits of deescalating treatment or changing medications when a patient is receiving concomitant TNF inhibitors and azathioprine/6-mercaptopurine,” they write.
 

Findings mirror those seen in other settings

These findings are in line with what has been found in other settings, according to Joel M. Gelfand, MD, director of the psoriasis and phototherapy treatment center, vice chair of clinical research, and medical director of the dermatology clinical studies unit at the University of Pennsylvania, Philadelphia.

“In the beginning of the pandemic, there was concern about use of immune-modulating treatments, and many patients self-discontinued treatments like TNF inhibitors,” Dr. Gelfand, who was not involved in the study, told this news organization. “This has ultimately proved unnecessary and unfortunately resulted in harm to many patients due to flaring of their underlying disease.”

Dr. Gelfand emphasized the importance of vaccinating patients against COVID-19 as soon as possible and of getting a third dose for those who are already fully vaccinated with the Pfizer or Moderna shots, as recommended by the Centers for Disease Control and Prevention.

“I typically recommend this third dose be taken 6 months after the second dose,” Dr. Gelfand said. “The good news is that TNF inhibitors do not seem to meaningfully impact response to mRNA vaccines.”
 

Study details

The researchers analyzed data from three international registries of adults with rheumatic diseases, inflammatory bowel disease, and psoriasis who had COVID-19 between March 12, 2020, and Feb. 1, 2021. The registries included the Secure Epidemiology of Coronavirus Under Research Exclusion for Inflammatory Bowel Disease (SECURE-IBD) registry, the Psoriasis Patient Registry for Outcomes, Therapy and Epidemiology of COVID-19 Infection (PsoProtect), and the physician-reported registry from the Global Rheumatology Alliance (GRA).

The population included 6,077 patients from 74 countries. About half of the cohort (52.9%) were from Europe; more than half were women (58.6%). The average age was 48 years. A little over one-third of the patients (35.3%) had rheumatoid arthritis, 25.3% had Crohn’s disease, 12.5% had ulcerative colitis, 10.3% had spondyloarthritis, and 9.3% had psoriatic arthritis. Smaller percentages had psoriasis (4.9%), another type of arthritis or multiple types (1.7%), or another inflammatory bowel disease (0.6%).

One in five patients (21.3%) were hospitalized, and 3.1% died. The researchers compared outcomes for those who were receiving TNF inhibitor therapy alone to outcomes for those who were taking azathioprine/6-mercaptopurine therapy (alone or with a TNF inhibitor), methotrexate (alone or with a TNF inhibitor), and Janus kinase (JAK) inhibitors. They adjusted their analysis to account for active disease and common comorbidities, as well as geography and the period during the pandemic in which the person was admitted, because treatment regimens and hospitalization indications have varied over time.

All of the therapies except the combination of TNF inhibitors and methotrexate were associated with higher odds of hospitalization and death than TNF inhibitor monotherapy.

The researchers explored several possible explanations for the findings, including the possibility that high serum TNF concentrations may have been associated with more organ damage at the time of COVID-19 admission, owing to interaction with SARS-CoV-2–associated hyperinflammation.

“Therefore, blocking TNF could inhibit this detrimental immune response,” the authors write. “Multiple case series reporting favorable outcomes among patients receiving TNF inhibitor therapy support this assertion.”

Another possibility relates to the effects of taking non–TNF inhibitor medications for immunosuppression. The authors note that thiopurine medications are linked to a greater risk for opportunistic viral infections and that JAK inhibitors may reduce the body’s ability to clear the virus because of its suppression of innate immune response.

The authors also postulate that methotrexate may lower the likelihood of cytokine storm linked to COVID-19, even though methotrexate monotherapy was associated with poorer outcomes. “This association could mean that TNF inhibitor therapy is exerting a protective benefit or that methotrexate therapy is exerting a harmful consequence,” the authors write.

 

Caution needed in interpreting uncontrolled, registry-based data

The findings were not surprising to Stephen B. Hanauer, MD, medical director of the Digestive Health Center at Northwestern University, Chicago, who was not involved in the research.

Northwestern University

“We’ve been monitoring IBD [inflammatory bowel disease] patients through the Secure registry similar to the rheumatologic and dermatologic societies and have not identified a signal of harm from any international groups,” Dr. Hanauer told this news organization. He noted that these registries also have not shown an increased risk for COVID-19 complications among patients receiving TNF inhibitors, antiadhesion therapies, or anti–IL12/23 inhibitors, compared with the general population not taking these therapies.

The study’s size and the diversity of patients strengthen its findings. However, the registries’ use of convenience sampling increases the potential for reporting bias, although the results remained similar after a sensitivity analysis. The study also lacked a control group, and the registries did not collect data uniformly.

“These are databases that rely on reporting from investigators and are not comprehensive prospective studies,” Dr. Hanauer noted as another study limitation.

Dr. Gelfand similarly advised caution in interpreting these findings, inasmuch as the study is a “collection of spontaneous reports” that should be viewed as hypothesis-generating rather than testing.

“Fortunately, more rigorous studies have been conducted, typically in large medical record systems, and have confirmed the hypothesis that TNF inhibitors are associated with a lower risk of poor COVID-19 outcomes, compared to other treatments,” Dr. Gelfand said.

Previous smaller studies similarly found better outcomes among patients taking TNF inhibitors, compared with other therapies, but their participants were predominantly from North America and Europe, noted Licio A. Velloso, MD, PhD, of the University of Campinas, in São Paulo, in an accompanying commentary.

On the basis of the findings of this study, “which included a much larger sample comprising distinct diseases and patients with a multitude of genetic backgrounds, the evidence in favor of the continued use of TNF inhibitor monotherapy for patients with IMIDs during the COVID-19 pandemic has become more substantial,” Dr. Velloso writes. “The finding that maintenance of TNF inhibitor monotherapy is associated with reductions in the risk of severe COVID-19 among patients with IMIDs offers new perspective that may guide health care professionals in the difficult decisions regarding therapeutic approaches among this specific group of patients.”

The research was funded by the American College of Rheumatology, the European Alliance of Associations for Rheumatology, the United Kingdom’s National Institute for Health Research Biomedical Research Center, and the Psoriasis Association. Many authors reported receiving grants and/or personal fees from a variety of pharmaceutical companies. Dr. Velloso has disclosed no relevant financial relationships. Dr. Hanauer has served as a consultant to companies that market TNF inhibitors. Dr. Gelfand has consulted for and received research grants from companies that market TNF inhibitors.

A version of this article first appeared on Medscape.com.