MDedge Rheumatology

The incidence of venous thromboembolism (VTE) in nonhospitalized patients with COVID-19 was not significantly different from patients without the infectious disease, according to a new study published in JAMA Internal Medicine.

Design Cells/Getty Images

National Institutes of Health guidelines recommend blood thinners to prevent blood clots in patients hospitalized with COVID-19. However, the new study provides more insight on the best treatment approach for COVID-19 outpatients.

“[COVID-19’s] rapid global progression and impact has caused us to make and modify treatment decisions at a pace that we never have in modern medicine,” study author Nareg Roubinian, MD, an investigator at Kaiser Permanente, Oakland, Calif., said in an interview.

“As with other potential therapies for COVID-19, blood thinners need to be prospectively studied in a clinical trial to determine if they improve patient outcomes,” Dr. Roubinian added.

The increased risk of blood clots in patients hospitalized with COVID-19 has been a major issue throughout the pandemic. In fact, one study published in November 2020 found that more than half of patients hospitalized with the illness have prothrombotic antiphospholipid (aPL) autoantibodies in their blood, which could contribute to venous and arterial thromboembolism.

Although it was clear many hospitalized patients diagnosed with COVID-19 were developing more clots, researchers of the current study were not sure if this trend would also be seen in outpatients.

“Most people with COVID-19 do not need to be hospitalized, and we needed to know how often patients outside the hospital were having blood clots,” said Dr. Roubinian.

For the study, Dr. Roubinian and colleagues examined data on 220,588 patients who were members of Kaiser Permanente Northern California health plan and were tested for COVID-19 between Feb. 25 and Aug. 31, 2020. They then reported on the 30-day incidence of outpatient and hospital-associated blood clots following the COVID-19 diagnosis. Patients who were asymptomatic at the time of testing or had received anticoagulants within the last year were excluded.

“We knew from other studies that patients with COVID-19 often get sicker in the first few weeks after infection. What we didn’t know was whether COVID-19 patients were developing blood clots but not pneumonia or were developing blood clots at the same time as they developed pneumonia,” said Dr. Roubinian, an intensive care doctor with the Permanente Medical Group in Oakland, Calif. “Following the patients for 30 days allowed us to focus on the time period from infection to when blood clots were most likely to develop.”

Researchers found that of the cohort who took the COVID-19 test, 11.8% had a positive result. Within 30 days of the COVID-19 test, 0.8% of patients with a positive result were diagnosed with VTE compared to 0.5% of those who received a negative test result. They also found that viral testing took place in an outpatient setting for 59.1% of the patients with a positive viral test who later developed VTE. Of those patients, 76.1% had to be hospitalized.

Dr. Roubinian said he was surprised to see that the blood clotting in outpatients with COVID-19 was similar in frequency to what he saw in patients without the infection.

“Our findings suggest that blood clots do occur in COVID-19 patients but not on a scale where we need to put all or many COVID outpatients on blood thinners,” he said. “As with other potential therapies for COVID-19, blood thinners need to be prospectively studied in a clinical trial to determine if they improve patient outcomes.”

In December 2020, three trials investigating the risk and benefits of increased levels of anticoagulation in hospitalized COVID-19 patients were paused because of safety issues. The trials would have enrolled critically ill COVID-19 patients for whom therapeutic doses of anticoagulation drugs showed no benefit.

Anticoagulants are associated with bleeding risks, including prolonged nosebleeds and vomiting or coughing up blood.

Instead of prescribing the routine use of thromboprophylactic drugs to COVID-19 outpatients, Dr. Roubinian believes it would be helpful to learn how to determine whether a patient at risk of becoming sick or being hospitalized would benefit from being treated with such drugs.

Dr. Roubinian reported receiving grants from the National Institutes of Health and the National Heart, Lung, and Blood Institute during the conduct of the study.
 

The incidence of venous thromboembolism (VTE) in nonhospitalized patients with COVID-19 was not significantly different from patients without the infectious disease, according to a new study published in JAMA Internal Medicine.

Design Cells/Getty Images

National Institutes of Health guidelines recommend blood thinners to prevent blood clots in patients hospitalized with COVID-19. However, the new study provides more insight on the best treatment approach for COVID-19 outpatients.

“[COVID-19’s] rapid global progression and impact has caused us to make and modify treatment decisions at a pace that we never have in modern medicine,” study author Nareg Roubinian, MD, an investigator at Kaiser Permanente, Oakland, Calif., said in an interview.

“As with other potential therapies for COVID-19, blood thinners need to be prospectively studied in a clinical trial to determine if they improve patient outcomes,” Dr. Roubinian added.

The increased risk of blood clots in patients hospitalized with COVID-19 has been a major issue throughout the pandemic. In fact, one study published in November 2020 found that more than half of patients hospitalized with the illness have prothrombotic antiphospholipid (aPL) autoantibodies in their blood, which could contribute to venous and arterial thromboembolism.

Although it was clear many hospitalized patients diagnosed with COVID-19 were developing more clots, researchers of the current study were not sure if this trend would also be seen in outpatients.

“Most people with COVID-19 do not need to be hospitalized, and we needed to know how often patients outside the hospital were having blood clots,” said Dr. Roubinian.

For the study, Dr. Roubinian and colleagues examined data on 220,588 patients who were members of Kaiser Permanente Northern California health plan and were tested for COVID-19 between Feb. 25 and Aug. 31, 2020. They then reported on the 30-day incidence of outpatient and hospital-associated blood clots following the COVID-19 diagnosis. Patients who were asymptomatic at the time of testing or had received anticoagulants within the last year were excluded.

“We knew from other studies that patients with COVID-19 often get sicker in the first few weeks after infection. What we didn’t know was whether COVID-19 patients were developing blood clots but not pneumonia or were developing blood clots at the same time as they developed pneumonia,” said Dr. Roubinian, an intensive care doctor with the Permanente Medical Group in Oakland, Calif. “Following the patients for 30 days allowed us to focus on the time period from infection to when blood clots were most likely to develop.”

Researchers found that of the cohort who took the COVID-19 test, 11.8% had a positive result. Within 30 days of the COVID-19 test, 0.8% of patients with a positive result were diagnosed with VTE compared to 0.5% of those who received a negative test result. They also found that viral testing took place in an outpatient setting for 59.1% of the patients with a positive viral test who later developed VTE. Of those patients, 76.1% had to be hospitalized.

Dr. Roubinian said he was surprised to see that the blood clotting in outpatients with COVID-19 was similar in frequency to what he saw in patients without the infection.

“Our findings suggest that blood clots do occur in COVID-19 patients but not on a scale where we need to put all or many COVID outpatients on blood thinners,” he said. “As with other potential therapies for COVID-19, blood thinners need to be prospectively studied in a clinical trial to determine if they improve patient outcomes.”

In December 2020, three trials investigating the risk and benefits of increased levels of anticoagulation in hospitalized COVID-19 patients were paused because of safety issues. The trials would have enrolled critically ill COVID-19 patients for whom therapeutic doses of anticoagulation drugs showed no benefit.

Anticoagulants are associated with bleeding risks, including prolonged nosebleeds and vomiting or coughing up blood.

Instead of prescribing the routine use of thromboprophylactic drugs to COVID-19 outpatients, Dr. Roubinian believes it would be helpful to learn how to determine whether a patient at risk of becoming sick or being hospitalized would benefit from being treated with such drugs.

Dr. Roubinian reported receiving grants from the National Institutes of Health and the National Heart, Lung, and Blood Institute during the conduct of the study.
 

The incidence of venous thromboembolism (VTE) in nonhospitalized patients with COVID-19 was not significantly different from patients without the infectious disease, according to a new study published in JAMA Internal Medicine.

Design Cells/Getty Images

National Institutes of Health guidelines recommend blood thinners to prevent blood clots in patients hospitalized with COVID-19. However, the new study provides more insight on the best treatment approach for COVID-19 outpatients.

“[COVID-19’s] rapid global progression and impact has caused us to make and modify treatment decisions at a pace that we never have in modern medicine,” study author Nareg Roubinian, MD, an investigator at Kaiser Permanente, Oakland, Calif., said in an interview.

“As with other potential therapies for COVID-19, blood thinners need to be prospectively studied in a clinical trial to determine if they improve patient outcomes,” Dr. Roubinian added.

The increased risk of blood clots in patients hospitalized with COVID-19 has been a major issue throughout the pandemic. In fact, one study published in November 2020 found that more than half of patients hospitalized with the illness have prothrombotic antiphospholipid (aPL) autoantibodies in their blood, which could contribute to venous and arterial thromboembolism.

Although it was clear many hospitalized patients diagnosed with COVID-19 were developing more clots, researchers of the current study were not sure if this trend would also be seen in outpatients.

“Most people with COVID-19 do not need to be hospitalized, and we needed to know how often patients outside the hospital were having blood clots,” said Dr. Roubinian.

For the study, Dr. Roubinian and colleagues examined data on 220,588 patients who were members of Kaiser Permanente Northern California health plan and were tested for COVID-19 between Feb. 25 and Aug. 31, 2020. They then reported on the 30-day incidence of outpatient and hospital-associated blood clots following the COVID-19 diagnosis. Patients who were asymptomatic at the time of testing or had received anticoagulants within the last year were excluded.

“We knew from other studies that patients with COVID-19 often get sicker in the first few weeks after infection. What we didn’t know was whether COVID-19 patients were developing blood clots but not pneumonia or were developing blood clots at the same time as they developed pneumonia,” said Dr. Roubinian, an intensive care doctor with the Permanente Medical Group in Oakland, Calif. “Following the patients for 30 days allowed us to focus on the time period from infection to when blood clots were most likely to develop.”

Researchers found that of the cohort who took the COVID-19 test, 11.8% had a positive result. Within 30 days of the COVID-19 test, 0.8% of patients with a positive result were diagnosed with VTE compared to 0.5% of those who received a negative test result. They also found that viral testing took place in an outpatient setting for 59.1% of the patients with a positive viral test who later developed VTE. Of those patients, 76.1% had to be hospitalized.

Dr. Roubinian said he was surprised to see that the blood clotting in outpatients with COVID-19 was similar in frequency to what he saw in patients without the infection.

“Our findings suggest that blood clots do occur in COVID-19 patients but not on a scale where we need to put all or many COVID outpatients on blood thinners,” he said. “As with other potential therapies for COVID-19, blood thinners need to be prospectively studied in a clinical trial to determine if they improve patient outcomes.”

In December 2020, three trials investigating the risk and benefits of increased levels of anticoagulation in hospitalized COVID-19 patients were paused because of safety issues. The trials would have enrolled critically ill COVID-19 patients for whom therapeutic doses of anticoagulation drugs showed no benefit.

Anticoagulants are associated with bleeding risks, including prolonged nosebleeds and vomiting or coughing up blood.

Instead of prescribing the routine use of thromboprophylactic drugs to COVID-19 outpatients, Dr. Roubinian believes it would be helpful to learn how to determine whether a patient at risk of becoming sick or being hospitalized would benefit from being treated with such drugs.

Dr. Roubinian reported receiving grants from the National Institutes of Health and the National Heart, Lung, and Blood Institute during the conduct of the study.
 

Iguratimod (IGU) is a novel small-molecule synthetic DMARD being studied for RA; its exact mechanism is unknown, but it inhibits NF-kB activation and seems to reduce bone resorption via RANKL and cartilage erosion via matrix metalloproteinases. Currently, it is approved in Japan and China for treatment of RA; initial studies from 2008-2010 showed improved ACR20 rates compared to placebo and comparable rates with methotrexate monotherapy; combination therapy with methotrexate appears to be more effective than either methotrexate or IGU monotherapy. Yoshikawa et al present a small study of 47 patients receiving methotrexate or methotrexate with IGU and show promising results regarding tapering of methotrexate with sustained remission/low disease activity and decrease in ultrasound evidence of synovitis in patients receiving IGU, suggesting that it is a reasonable longer-term option for RA patients. However, the medication is not approved in the US, nor have studies in patients in the US been published, so generalizability in patients outside of Japan and China is uncertain, in addition to concerns related to the small sample size.

In contrast, tocilizumab is an established therapy for RA; Pappas et al present real-world clinical practice data from the Corrona RA registry. Among nearly 1800 RA patients who initiated tocilizumab therapy, the mean durability of response was over 3 years in terms of maintaining minimum clinically important difference (MCID) over baseline CDAI and over 1 year in terms of maintaining low disease activity. Most patients in the study had previously received biologic therapy. Though the observational nature of the study limits its generalizability, the addition of efficacy data to persistence on therapy lend weight to this evidence regarding durability of response to tocilizumab, as the proportion of patients maintaining MCID was >50% at 3 years.

Treatment options are limited for RA patients who have ILD or other pulmonary complications. The fear of causing or exacerbating pulmonary toxicity limits the use of methotrexate, leflunomide, and anti-TNF biologics. Some data support the safety of rituximab and abatacept. A retrospective observational study looked at outcomes in RA patients on rituximab and JAK inhibitors. Reassuringly, respiratory event rates were no different between the two groups though number of patients and trial design prevents wider generalization; it is also unknown whether RA-ILD improves with ritixumab or JAK-inhibition. However, given these results, studying JAK inhibitors in larger prospective studies would be reasonable.

Iguratimod (IGU) is a novel small-molecule synthetic DMARD being studied for RA; its exact mechanism is unknown, but it inhibits NF-kB activation and seems to reduce bone resorption via RANKL and cartilage erosion via matrix metalloproteinases. Currently, it is approved in Japan and China for treatment of RA; initial studies from 2008-2010 showed improved ACR20 rates compared to placebo and comparable rates with methotrexate monotherapy; combination therapy with methotrexate appears to be more effective than either methotrexate or IGU monotherapy. Yoshikawa et al present a small study of 47 patients receiving methotrexate or methotrexate with IGU and show promising results regarding tapering of methotrexate with sustained remission/low disease activity and decrease in ultrasound evidence of synovitis in patients receiving IGU, suggesting that it is a reasonable longer-term option for RA patients. However, the medication is not approved in the US, nor have studies in patients in the US been published, so generalizability in patients outside of Japan and China is uncertain, in addition to concerns related to the small sample size.

In contrast, tocilizumab is an established therapy for RA; Pappas et al present real-world clinical practice data from the Corrona RA registry. Among nearly 1800 RA patients who initiated tocilizumab therapy, the mean durability of response was over 3 years in terms of maintaining minimum clinically important difference (MCID) over baseline CDAI and over 1 year in terms of maintaining low disease activity. Most patients in the study had previously received biologic therapy. Though the observational nature of the study limits its generalizability, the addition of efficacy data to persistence on therapy lend weight to this evidence regarding durability of response to tocilizumab, as the proportion of patients maintaining MCID was >50% at 3 years.

Treatment options are limited for RA patients who have ILD or other pulmonary complications. The fear of causing or exacerbating pulmonary toxicity limits the use of methotrexate, leflunomide, and anti-TNF biologics. Some data support the safety of rituximab and abatacept. A retrospective observational study looked at outcomes in RA patients on rituximab and JAK inhibitors. Reassuringly, respiratory event rates were no different between the two groups though number of patients and trial design prevents wider generalization; it is also unknown whether RA-ILD improves with ritixumab or JAK-inhibition. However, given these results, studying JAK inhibitors in larger prospective studies would be reasonable.

Iguratimod (IGU) is a novel small-molecule synthetic DMARD being studied for RA; its exact mechanism is unknown, but it inhibits NF-kB activation and seems to reduce bone resorption via RANKL and cartilage erosion via matrix metalloproteinases. Currently, it is approved in Japan and China for treatment of RA; initial studies from 2008-2010 showed improved ACR20 rates compared to placebo and comparable rates with methotrexate monotherapy; combination therapy with methotrexate appears to be more effective than either methotrexate or IGU monotherapy. Yoshikawa et al present a small study of 47 patients receiving methotrexate or methotrexate with IGU and show promising results regarding tapering of methotrexate with sustained remission/low disease activity and decrease in ultrasound evidence of synovitis in patients receiving IGU, suggesting that it is a reasonable longer-term option for RA patients. However, the medication is not approved in the US, nor have studies in patients in the US been published, so generalizability in patients outside of Japan and China is uncertain, in addition to concerns related to the small sample size.

In contrast, tocilizumab is an established therapy for RA; Pappas et al present real-world clinical practice data from the Corrona RA registry. Among nearly 1800 RA patients who initiated tocilizumab therapy, the mean durability of response was over 3 years in terms of maintaining minimum clinically important difference (MCID) over baseline CDAI and over 1 year in terms of maintaining low disease activity. Most patients in the study had previously received biologic therapy. Though the observational nature of the study limits its generalizability, the addition of efficacy data to persistence on therapy lend weight to this evidence regarding durability of response to tocilizumab, as the proportion of patients maintaining MCID was >50% at 3 years.

Treatment options are limited for RA patients who have ILD or other pulmonary complications. The fear of causing or exacerbating pulmonary toxicity limits the use of methotrexate, leflunomide, and anti-TNF biologics. Some data support the safety of rituximab and abatacept. A retrospective observational study looked at outcomes in RA patients on rituximab and JAK inhibitors. Reassuringly, respiratory event rates were no different between the two groups though number of patients and trial design prevents wider generalization; it is also unknown whether RA-ILD improves with ritixumab or JAK-inhibition. However, given these results, studying JAK inhibitors in larger prospective studies would be reasonable.

Key clinical point: Considerable proportions of cases with rheumatoid arthritis (RA) are still difficult to treat in real world despite intensive treatment.

Major finding: Among patients with RA, 10.1% were categorized as having difficult-to-treat RA despite being treated intensively. Main reasons for difficulty in treating RA were multidrug resistance (34.1%), comorbidities (9.8%), and socioeconomic reasons (56.1%).

Study details: Data come from an analysis of 1,709 patients with RA who visited Keio University Hospital between 2016 and 2017.

Disclosures: The study did not receive any funding. S Takanashi reported no conflicts of interest. Y Kaneko and T Takeuchi reported receiving grants or speaker fees from various sources.

Source: Takanashi S et al. Rheumatology (Oxford). 2021 Mar 2. doi: 10.1093/rheumatology/keab209.

Key clinical point: Considerable proportions of cases with rheumatoid arthritis (RA) are still difficult to treat in real world despite intensive treatment.

Major finding: Among patients with RA, 10.1% were categorized as having difficult-to-treat RA despite being treated intensively. Main reasons for difficulty in treating RA were multidrug resistance (34.1%), comorbidities (9.8%), and socioeconomic reasons (56.1%).

Study details: Data come from an analysis of 1,709 patients with RA who visited Keio University Hospital between 2016 and 2017.

Disclosures: The study did not receive any funding. S Takanashi reported no conflicts of interest. Y Kaneko and T Takeuchi reported receiving grants or speaker fees from various sources.

Source: Takanashi S et al. Rheumatology (Oxford). 2021 Mar 2. doi: 10.1093/rheumatology/keab209.

Key clinical point: Considerable proportions of cases with rheumatoid arthritis (RA) are still difficult to treat in real world despite intensive treatment.

Major finding: Among patients with RA, 10.1% were categorized as having difficult-to-treat RA despite being treated intensively. Main reasons for difficulty in treating RA were multidrug resistance (34.1%), comorbidities (9.8%), and socioeconomic reasons (56.1%).

Study details: Data come from an analysis of 1,709 patients with RA who visited Keio University Hospital between 2016 and 2017.

Disclosures: The study did not receive any funding. S Takanashi reported no conflicts of interest. Y Kaneko and T Takeuchi reported receiving grants or speaker fees from various sources.

Source: Takanashi S et al. Rheumatology (Oxford). 2021 Mar 2. doi: 10.1093/rheumatology/keab209.

Key clinical point: Low cardiorespiratory fitness (CRF) is an important mediator of increased long-term all-cause mortality among patients with rheumatoid arthritis (RA).

Major finding: Patients with RA having CRF below sex-specific and age-specific median had a 28% excess relative risk of mortality (P = .035), of which 5% was associated with the disease itself and 23% was mediated by direct and indirect effects of low CRF.

Study details: Data come from an analysis of patients with RA (n=348) and controls (n=60,938) who participated in the second and third waves of the longitudinal population-based Trøndelag Health Study.

Disclosures: This project was funded by a grant to MH Liff from the Central Norway Regional Health Authority, allocated via the Liaison Committee for Education, Research and Innovation in Central Norway. All the authors declared no conflicts of interest.

Source: Liff MH et al. RMD Open. 2021 March 8. doi: 10.1136/rmdopen-2020-001545.

Key clinical point: Low cardiorespiratory fitness (CRF) is an important mediator of increased long-term all-cause mortality among patients with rheumatoid arthritis (RA).

Major finding: Patients with RA having CRF below sex-specific and age-specific median had a 28% excess relative risk of mortality (P = .035), of which 5% was associated with the disease itself and 23% was mediated by direct and indirect effects of low CRF.

Study details: Data come from an analysis of patients with RA (n=348) and controls (n=60,938) who participated in the second and third waves of the longitudinal population-based Trøndelag Health Study.

Disclosures: This project was funded by a grant to MH Liff from the Central Norway Regional Health Authority, allocated via the Liaison Committee for Education, Research and Innovation in Central Norway. All the authors declared no conflicts of interest.

Source: Liff MH et al. RMD Open. 2021 March 8. doi: 10.1136/rmdopen-2020-001545.

Key clinical point: Low cardiorespiratory fitness (CRF) is an important mediator of increased long-term all-cause mortality among patients with rheumatoid arthritis (RA).

Major finding: Patients with RA having CRF below sex-specific and age-specific median had a 28% excess relative risk of mortality (P = .035), of which 5% was associated with the disease itself and 23% was mediated by direct and indirect effects of low CRF.

Study details: Data come from an analysis of patients with RA (n=348) and controls (n=60,938) who participated in the second and third waves of the longitudinal population-based Trøndelag Health Study.

Disclosures: This project was funded by a grant to MH Liff from the Central Norway Regional Health Authority, allocated via the Liaison Committee for Education, Research and Innovation in Central Norway. All the authors declared no conflicts of interest.

Source: Liff MH et al. RMD Open. 2021 March 8. doi: 10.1136/rmdopen-2020-001545.

Key clinical point: Frailty is positively associated with disease activity in rheumatoid arthritis (RA), and habitual fish intake may help prevent progression of frailty and RA.

Major finding: The presence of frailty was significantly associated with the disease activity score (Disease Activity Score 28-erythrocyte sedimentation rate; odds ratio [OR], 1.70; P less than .0001). Patients who consumed fish more than twice per week had a lower prevalence of frailty than those who consumed fish twice per week or lesser (OR, 0.35; P = .00060).

Study details: The data come from a cross-sectional study of 306 female outpatients with RA from the KURAMA cohort database.

Disclosures: KURAMA cohort study was supported by AMED and a grant from the Daiichi Sankyo Co. Ltd. M. Hashimoto, R Watanabe, K Nishitani, H Ito, K Ohmura, and S Matsuda reported to receive grants and/or speaker fees from various pharmaceutical companies including Bristol-Meyers, Mitsubishi Tanabe Pharma, Asahi-Kasei Pharma, Daiichi-Sankyo, etc. Some of the authors declared no conflicts of interest.

Source: Minamino H et al. Sci Rep. 2021 Mar 3. doi: 10.1038/s41598-021-84479-0.

Key clinical point: Frailty is positively associated with disease activity in rheumatoid arthritis (RA), and habitual fish intake may help prevent progression of frailty and RA.

Major finding: The presence of frailty was significantly associated with the disease activity score (Disease Activity Score 28-erythrocyte sedimentation rate; odds ratio [OR], 1.70; P less than .0001). Patients who consumed fish more than twice per week had a lower prevalence of frailty than those who consumed fish twice per week or lesser (OR, 0.35; P = .00060).

Study details: The data come from a cross-sectional study of 306 female outpatients with RA from the KURAMA cohort database.

Disclosures: KURAMA cohort study was supported by AMED and a grant from the Daiichi Sankyo Co. Ltd. M. Hashimoto, R Watanabe, K Nishitani, H Ito, K Ohmura, and S Matsuda reported to receive grants and/or speaker fees from various pharmaceutical companies including Bristol-Meyers, Mitsubishi Tanabe Pharma, Asahi-Kasei Pharma, Daiichi-Sankyo, etc. Some of the authors declared no conflicts of interest.

Source: Minamino H et al. Sci Rep. 2021 Mar 3. doi: 10.1038/s41598-021-84479-0.

Key clinical point: Frailty is positively associated with disease activity in rheumatoid arthritis (RA), and habitual fish intake may help prevent progression of frailty and RA.

Major finding: The presence of frailty was significantly associated with the disease activity score (Disease Activity Score 28-erythrocyte sedimentation rate; odds ratio [OR], 1.70; P less than .0001). Patients who consumed fish more than twice per week had a lower prevalence of frailty than those who consumed fish twice per week or lesser (OR, 0.35; P = .00060).

Study details: The data come from a cross-sectional study of 306 female outpatients with RA from the KURAMA cohort database.

Disclosures: KURAMA cohort study was supported by AMED and a grant from the Daiichi Sankyo Co. Ltd. M. Hashimoto, R Watanabe, K Nishitani, H Ito, K Ohmura, and S Matsuda reported to receive grants and/or speaker fees from various pharmaceutical companies including Bristol-Meyers, Mitsubishi Tanabe Pharma, Asahi-Kasei Pharma, Daiichi-Sankyo, etc. Some of the authors declared no conflicts of interest.

Source: Minamino H et al. Sci Rep. 2021 Mar 3. doi: 10.1038/s41598-021-84479-0.

Key clinical point: Rheumatoid arthritis (RA) is associated with poor long-term prognosis after myocardial infarction (MI).

Major finding: At 14-year follow-up after MI, the cumulative all-cause mortality risk was significantly higher among patients with vs. without RA (80.4% vs. 72.3%; hazard ratio [HR], 1.25; P less than .0001). Patients with RA had a higher risk for new MI (HR, 1.22; P = .0001) and revascularization (HR, 1.27; P = .002) after discharge from index MI.

Study details: This was a nationwide, multicenter, cohort register study of real-life MI patients with RA (n=1,614) retrospectively compared with propensity score-matched MI patients without RA (n=8,070).

Disclosures: This study was supported by grant funding from the Finnish Cultural Foundation, the Paulo Foundation, and the Finnish Governmental VTR-funding. A Palomäki, AM Kerola, M Malmberg, and V Kytö reported relevant relationships with various pharmaceutical companies and/or research organizations. The other author declared no conflicts of interest.

Source: Palomäki A et al. Rheumatology (Oxford). 2021 Mar 1. doi: 10.1093/rheumatology/keab204.

Key clinical point: Rheumatoid arthritis (RA) is associated with poor long-term prognosis after myocardial infarction (MI).

Major finding: At 14-year follow-up after MI, the cumulative all-cause mortality risk was significantly higher among patients with vs. without RA (80.4% vs. 72.3%; hazard ratio [HR], 1.25; P less than .0001). Patients with RA had a higher risk for new MI (HR, 1.22; P = .0001) and revascularization (HR, 1.27; P = .002) after discharge from index MI.

Study details: This was a nationwide, multicenter, cohort register study of real-life MI patients with RA (n=1,614) retrospectively compared with propensity score-matched MI patients without RA (n=8,070).

Disclosures: This study was supported by grant funding from the Finnish Cultural Foundation, the Paulo Foundation, and the Finnish Governmental VTR-funding. A Palomäki, AM Kerola, M Malmberg, and V Kytö reported relevant relationships with various pharmaceutical companies and/or research organizations. The other author declared no conflicts of interest.

Source: Palomäki A et al. Rheumatology (Oxford). 2021 Mar 1. doi: 10.1093/rheumatology/keab204.

Key clinical point: Rheumatoid arthritis (RA) is associated with poor long-term prognosis after myocardial infarction (MI).

Major finding: At 14-year follow-up after MI, the cumulative all-cause mortality risk was significantly higher among patients with vs. without RA (80.4% vs. 72.3%; hazard ratio [HR], 1.25; P less than .0001). Patients with RA had a higher risk for new MI (HR, 1.22; P = .0001) and revascularization (HR, 1.27; P = .002) after discharge from index MI.

Study details: This was a nationwide, multicenter, cohort register study of real-life MI patients with RA (n=1,614) retrospectively compared with propensity score-matched MI patients without RA (n=8,070).

Disclosures: This study was supported by grant funding from the Finnish Cultural Foundation, the Paulo Foundation, and the Finnish Governmental VTR-funding. A Palomäki, AM Kerola, M Malmberg, and V Kytö reported relevant relationships with various pharmaceutical companies and/or research organizations. The other author declared no conflicts of interest.

Source: Palomäki A et al. Rheumatology (Oxford). 2021 Mar 1. doi: 10.1093/rheumatology/keab204.

Key clinical point: Multi-Biomarker Disease Activity (MBDA) should not be preferred to assess clinically meaningful improvements in disease activity after repository corticotropin injection (RCI) therapy in patients with active rheumatoid arthritis (RA).

Major finding: RCI-mediated improvements in Disease Activity Score 28-erythrocyte sedimentation rate and Clinical Disease Activity Index scores suggested clinically meaningful improvement with more than 84% of patients meeting the minimal clinically important difference/minimally important difference criteria, which ranged from 26.3% to 34.7% for MBDA.

Study details: The data come from a multicenter, randomized, placebo-controlled study of 259 patients with active RA despite treatment with stable glucocorticoid dose and 1 or 2 disease-modifying anti-rheumatic drugs. Patients achieving low disease activity during open-label period were randomly assigned to either 80 U of RCI (n=77) or placebo (n=76) during the 12-week double-blind period.

Disclosures: This study was funded by Mallinckrodt Pharmaceuticals. R Fleischmann, DE Furst, and OG Segurado reported receiving clinical trial grants and consulting fees from various pharmaceutical companies including Mallinckrodt Pharmaceuticals. J Liu and J Zhu declared being employees of Mallinckrodt Pharmaceuticals.

Source: Fleischmann R et al. Arthritis Care Res (Hoboken). 2021 Feb 28. doi: 10.1002/acr.24583.

Key clinical point: Multi-Biomarker Disease Activity (MBDA) should not be preferred to assess clinically meaningful improvements in disease activity after repository corticotropin injection (RCI) therapy in patients with active rheumatoid arthritis (RA).

Major finding: RCI-mediated improvements in Disease Activity Score 28-erythrocyte sedimentation rate and Clinical Disease Activity Index scores suggested clinically meaningful improvement with more than 84% of patients meeting the minimal clinically important difference/minimally important difference criteria, which ranged from 26.3% to 34.7% for MBDA.

Study details: The data come from a multicenter, randomized, placebo-controlled study of 259 patients with active RA despite treatment with stable glucocorticoid dose and 1 or 2 disease-modifying anti-rheumatic drugs. Patients achieving low disease activity during open-label period were randomly assigned to either 80 U of RCI (n=77) or placebo (n=76) during the 12-week double-blind period.

Disclosures: This study was funded by Mallinckrodt Pharmaceuticals. R Fleischmann, DE Furst, and OG Segurado reported receiving clinical trial grants and consulting fees from various pharmaceutical companies including Mallinckrodt Pharmaceuticals. J Liu and J Zhu declared being employees of Mallinckrodt Pharmaceuticals.

Source: Fleischmann R et al. Arthritis Care Res (Hoboken). 2021 Feb 28. doi: 10.1002/acr.24583.

Key clinical point: Multi-Biomarker Disease Activity (MBDA) should not be preferred to assess clinically meaningful improvements in disease activity after repository corticotropin injection (RCI) therapy in patients with active rheumatoid arthritis (RA).

Major finding: RCI-mediated improvements in Disease Activity Score 28-erythrocyte sedimentation rate and Clinical Disease Activity Index scores suggested clinically meaningful improvement with more than 84% of patients meeting the minimal clinically important difference/minimally important difference criteria, which ranged from 26.3% to 34.7% for MBDA.

Study details: The data come from a multicenter, randomized, placebo-controlled study of 259 patients with active RA despite treatment with stable glucocorticoid dose and 1 or 2 disease-modifying anti-rheumatic drugs. Patients achieving low disease activity during open-label period were randomly assigned to either 80 U of RCI (n=77) or placebo (n=76) during the 12-week double-blind period.

Disclosures: This study was funded by Mallinckrodt Pharmaceuticals. R Fleischmann, DE Furst, and OG Segurado reported receiving clinical trial grants and consulting fees from various pharmaceutical companies including Mallinckrodt Pharmaceuticals. J Liu and J Zhu declared being employees of Mallinckrodt Pharmaceuticals.

Source: Fleischmann R et al. Arthritis Care Res (Hoboken). 2021 Feb 28. doi: 10.1002/acr.24583.

Key clinical point: Median durability of tocilizumab (TCZ) response was more than 3 years when measured as maintenance of minimum clinically important difference (MCID) in Clinical Disease Activity Index (CDAI) score in patients with RA initiating TCZ.

Major finding: Overall, durability of response among patients who initiated TCZ and achieved MCID in CDAI remained more than 50% after 3 years of follow-up. The proportion of patients maintaining MCID durability at 1, 2, and 3 years was 64.4% (95% CI, 59.2%-69.6%), 56.0% (95% CI, 50.0%-62.0%), and 51.8% (95% CI, 44.7%-58.9%), respectively.

Study details: The findings are from an observational study of 1,789 patients with RA who initiated TCZ and were enrolled in the US-based Corrona RA Registry.

Disclosures: This study was sponsored by Corrona LLC, and the analysis was funded by Genentech, Inc. DA Pappas, T Blachley, and K Emeanuru declared being employees and/or shareholders of Corrona, LLC. JH Best, WG Reiss, and S Zlotnick declared being current/former employees and/or shareholders of Genentech, Inc.

Source: Pappas DA et al. Rheumatol Ther. 2021 Feb 25. doi: 10.1007/s40744-021-00285-0.

Key clinical point: Median durability of tocilizumab (TCZ) response was more than 3 years when measured as maintenance of minimum clinically important difference (MCID) in Clinical Disease Activity Index (CDAI) score in patients with RA initiating TCZ.

Major finding: Overall, durability of response among patients who initiated TCZ and achieved MCID in CDAI remained more than 50% after 3 years of follow-up. The proportion of patients maintaining MCID durability at 1, 2, and 3 years was 64.4% (95% CI, 59.2%-69.6%), 56.0% (95% CI, 50.0%-62.0%), and 51.8% (95% CI, 44.7%-58.9%), respectively.

Study details: The findings are from an observational study of 1,789 patients with RA who initiated TCZ and were enrolled in the US-based Corrona RA Registry.

Disclosures: This study was sponsored by Corrona LLC, and the analysis was funded by Genentech, Inc. DA Pappas, T Blachley, and K Emeanuru declared being employees and/or shareholders of Corrona, LLC. JH Best, WG Reiss, and S Zlotnick declared being current/former employees and/or shareholders of Genentech, Inc.

Source: Pappas DA et al. Rheumatol Ther. 2021 Feb 25. doi: 10.1007/s40744-021-00285-0.

Key clinical point: Median durability of tocilizumab (TCZ) response was more than 3 years when measured as maintenance of minimum clinically important difference (MCID) in Clinical Disease Activity Index (CDAI) score in patients with RA initiating TCZ.

Major finding: Overall, durability of response among patients who initiated TCZ and achieved MCID in CDAI remained more than 50% after 3 years of follow-up. The proportion of patients maintaining MCID durability at 1, 2, and 3 years was 64.4% (95% CI, 59.2%-69.6%), 56.0% (95% CI, 50.0%-62.0%), and 51.8% (95% CI, 44.7%-58.9%), respectively.

Study details: The findings are from an observational study of 1,789 patients with RA who initiated TCZ and were enrolled in the US-based Corrona RA Registry.

Disclosures: This study was sponsored by Corrona LLC, and the analysis was funded by Genentech, Inc. DA Pappas, T Blachley, and K Emeanuru declared being employees and/or shareholders of Corrona, LLC. JH Best, WG Reiss, and S Zlotnick declared being current/former employees and/or shareholders of Genentech, Inc.

Source: Pappas DA et al. Rheumatol Ther. 2021 Feb 25. doi: 10.1007/s40744-021-00285-0.

Key clinical point: The addition of iguratimod (IGU) can effectively reduce methotrexate (MTX) dose required by rheumatoid arthritis (RA) patients with long-term clinical remission.

Major finding: MTX dose could be reduced from 8.6±2.4 mg/week to 4.7±2.2 mg/week at 36 weeks. Despite MTX dose reduction, disease activity score 28-erythrocyte sedimentation rate was maintained at 1.48 at baseline and 1.69 at 36 weeks (P = .911). Other than drug discontinuation by 2 patients in the IGU addition group, no other adverse events were observed.

Study details: Findings are from a prospective analysis of 47 patients with RA who had sustained clinical remission with MTX for more than 24 weeks. Patients either continued constant MTX dose (n=25) or were treated with additional IGU and tapered MTX dose (n=22).

Disclosures: No source of funding was declared. The authors declared no conflicts of interest.

Source: Yoshikawa A et al. Mod Rheumatol. 2021 Mar 16. doi: 10.1080/14397595.2021.1892945.

Key clinical point: The addition of iguratimod (IGU) can effectively reduce methotrexate (MTX) dose required by rheumatoid arthritis (RA) patients with long-term clinical remission.

Major finding: MTX dose could be reduced from 8.6±2.4 mg/week to 4.7±2.2 mg/week at 36 weeks. Despite MTX dose reduction, disease activity score 28-erythrocyte sedimentation rate was maintained at 1.48 at baseline and 1.69 at 36 weeks (P = .911). Other than drug discontinuation by 2 patients in the IGU addition group, no other adverse events were observed.

Study details: Findings are from a prospective analysis of 47 patients with RA who had sustained clinical remission with MTX for more than 24 weeks. Patients either continued constant MTX dose (n=25) or were treated with additional IGU and tapered MTX dose (n=22).

Disclosures: No source of funding was declared. The authors declared no conflicts of interest.

Source: Yoshikawa A et al. Mod Rheumatol. 2021 Mar 16. doi: 10.1080/14397595.2021.1892945.

Key clinical point: The addition of iguratimod (IGU) can effectively reduce methotrexate (MTX) dose required by rheumatoid arthritis (RA) patients with long-term clinical remission.

Major finding: MTX dose could be reduced from 8.6±2.4 mg/week to 4.7±2.2 mg/week at 36 weeks. Despite MTX dose reduction, disease activity score 28-erythrocyte sedimentation rate was maintained at 1.48 at baseline and 1.69 at 36 weeks (P = .911). Other than drug discontinuation by 2 patients in the IGU addition group, no other adverse events were observed.

Study details: Findings are from a prospective analysis of 47 patients with RA who had sustained clinical remission with MTX for more than 24 weeks. Patients either continued constant MTX dose (n=25) or were treated with additional IGU and tapered MTX dose (n=22).

Disclosures: No source of funding was declared. The authors declared no conflicts of interest.

Source: Yoshikawa A et al. Mod Rheumatol. 2021 Mar 16. doi: 10.1080/14397595.2021.1892945.

Key clinical point: Janus kinase inhibitors (JAKis: baricitinib or tofacitinib) vs. rituximab for the treatment of rheumatoid arthritis (RA) in patients with concurrent interstitial lung disease (ILD) or bronchiectasis did not increase the rate of hospitalization or mortality because of a respiratory cause.

Major finding: Respiratory events were reported in 5 patients treated with JAKi (18%; 7 hospitalizations, 2 of whom died) and 4 patients treated with rituximab (21%; 4 hospitalizations, 1 of whom died). Respiratory event survival (hazard ratio [HR], 1.38; P = .64) and the rate of drug discontinuation HR, 1.9; P = .251) did not differ significantly between groups.

Study details: A retrospective analysis of patients with RA and concurrent ILD or bronchiectasis who received JAKis (n=28: baricitinib, n=26; tofacitinib, n=2) or rituximab (n=19) for a mean of 1.1 and 2.14 years, respectively.

Disclosures: The study did not receive any funding. The lead author received sponsorship from Lilly and Pfizer to attend educational conferences. The other authors declared no conflicts of interest.

Citation: Cronin O et al. Rheumatol Int. 2021 Mar 15. doi: 10.1007/s00296-021-04835-1.

Key clinical point: Janus kinase inhibitors (JAKis: baricitinib or tofacitinib) vs. rituximab for the treatment of rheumatoid arthritis (RA) in patients with concurrent interstitial lung disease (ILD) or bronchiectasis did not increase the rate of hospitalization or mortality because of a respiratory cause.

Major finding: Respiratory events were reported in 5 patients treated with JAKi (18%; 7 hospitalizations, 2 of whom died) and 4 patients treated with rituximab (21%; 4 hospitalizations, 1 of whom died). Respiratory event survival (hazard ratio [HR], 1.38; P = .64) and the rate of drug discontinuation HR, 1.9; P = .251) did not differ significantly between groups.

Study details: A retrospective analysis of patients with RA and concurrent ILD or bronchiectasis who received JAKis (n=28: baricitinib, n=26; tofacitinib, n=2) or rituximab (n=19) for a mean of 1.1 and 2.14 years, respectively.

Disclosures: The study did not receive any funding. The lead author received sponsorship from Lilly and Pfizer to attend educational conferences. The other authors declared no conflicts of interest.

Citation: Cronin O et al. Rheumatol Int. 2021 Mar 15. doi: 10.1007/s00296-021-04835-1.

Key clinical point: Janus kinase inhibitors (JAKis: baricitinib or tofacitinib) vs. rituximab for the treatment of rheumatoid arthritis (RA) in patients with concurrent interstitial lung disease (ILD) or bronchiectasis did not increase the rate of hospitalization or mortality because of a respiratory cause.

Major finding: Respiratory events were reported in 5 patients treated with JAKi (18%; 7 hospitalizations, 2 of whom died) and 4 patients treated with rituximab (21%; 4 hospitalizations, 1 of whom died). Respiratory event survival (hazard ratio [HR], 1.38; P = .64) and the rate of drug discontinuation HR, 1.9; P = .251) did not differ significantly between groups.

Study details: A retrospective analysis of patients with RA and concurrent ILD or bronchiectasis who received JAKis (n=28: baricitinib, n=26; tofacitinib, n=2) or rituximab (n=19) for a mean of 1.1 and 2.14 years, respectively.

Disclosures: The study did not receive any funding. The lead author received sponsorship from Lilly and Pfizer to attend educational conferences. The other authors declared no conflicts of interest.

Citation: Cronin O et al. Rheumatol Int. 2021 Mar 15. doi: 10.1007/s00296-021-04835-1.