Clinical Edge Journal Scan

Key clinical point: Over 68-week continuous treatment, 4 mg and 2 mg baricitinib plus topical corticosteroids (TCS) showed clinically meaningful efficacy in patients with moderate-to-severe atopic dermatitis (AD).

Major finding: The proportions of patients with a validated Investigator’s Global Assessment for AD score of 0/1 at weeks 32/68 in the 4 mg baricitinib intent-to-treat, 4 mg baricitinib responder or partial responder (RPR), and 2 mg baricitinib RPR cohorts were 21.6%/23.5%, 31.7%/34.9%, and 45.3%/30.2%, respectively; Eczema Area and Severity Index 75 response rates were 46.1%/43.1%, 57.1%/49.2%, and 69.8%/58.5%, respectively.

Study details: This ongoing extension study of BREEZE-AD7 (BREEZE-AD3) included 292 patients with moderate-to-severe AD, of which RPR receiving 2 mg baricitinib +TCS/4 mg baricitinib + TCS continued their original treatment, nonresponders receiving 2 mg baricitinib were reassigned to receive 2 mg or 4 mg baricitinib, and nonresponders receiving 4 mg baricitinib continued their treatment.

Disclosures: This study was funded by Eli Lilly and Company, under license from Incyte Corporation. Some authors reported ties with various organizations, including Eli Lilly. Four authors declared being employees and stockholders of Eli Lilly.

Source: Silverberg JI et al. Long-term efficacy (up to 68 weeks) of baricitinib in combination with topical corticosteroids in adult patients with moderate-to-severe atopic dermatitis: Analysis of treatment responders, partial responders and nonresponders originating from study BREEZE-AD7. J Eur Acad Dermatol Venereol. 2023 (Dec 14, 2022). Doi: 10.1111/jdv.18816

Key clinical point: Over 68-week continuous treatment, 4 mg and 2 mg baricitinib plus topical corticosteroids (TCS) showed clinically meaningful efficacy in patients with moderate-to-severe atopic dermatitis (AD).

Major finding: The proportions of patients with a validated Investigator’s Global Assessment for AD score of 0/1 at weeks 32/68 in the 4 mg baricitinib intent-to-treat, 4 mg baricitinib responder or partial responder (RPR), and 2 mg baricitinib RPR cohorts were 21.6%/23.5%, 31.7%/34.9%, and 45.3%/30.2%, respectively; Eczema Area and Severity Index 75 response rates were 46.1%/43.1%, 57.1%/49.2%, and 69.8%/58.5%, respectively.

Study details: This ongoing extension study of BREEZE-AD7 (BREEZE-AD3) included 292 patients with moderate-to-severe AD, of which RPR receiving 2 mg baricitinib +TCS/4 mg baricitinib + TCS continued their original treatment, nonresponders receiving 2 mg baricitinib were reassigned to receive 2 mg or 4 mg baricitinib, and nonresponders receiving 4 mg baricitinib continued their treatment.

Disclosures: This study was funded by Eli Lilly and Company, under license from Incyte Corporation. Some authors reported ties with various organizations, including Eli Lilly. Four authors declared being employees and stockholders of Eli Lilly.

Source: Silverberg JI et al. Long-term efficacy (up to 68 weeks) of baricitinib in combination with topical corticosteroids in adult patients with moderate-to-severe atopic dermatitis: Analysis of treatment responders, partial responders and nonresponders originating from study BREEZE-AD7. J Eur Acad Dermatol Venereol. 2023 (Dec 14, 2022). Doi: 10.1111/jdv.18816

Key clinical point: Over 68-week continuous treatment, 4 mg and 2 mg baricitinib plus topical corticosteroids (TCS) showed clinically meaningful efficacy in patients with moderate-to-severe atopic dermatitis (AD).

Major finding: The proportions of patients with a validated Investigator’s Global Assessment for AD score of 0/1 at weeks 32/68 in the 4 mg baricitinib intent-to-treat, 4 mg baricitinib responder or partial responder (RPR), and 2 mg baricitinib RPR cohorts were 21.6%/23.5%, 31.7%/34.9%, and 45.3%/30.2%, respectively; Eczema Area and Severity Index 75 response rates were 46.1%/43.1%, 57.1%/49.2%, and 69.8%/58.5%, respectively.

Study details: This ongoing extension study of BREEZE-AD7 (BREEZE-AD3) included 292 patients with moderate-to-severe AD, of which RPR receiving 2 mg baricitinib +TCS/4 mg baricitinib + TCS continued their original treatment, nonresponders receiving 2 mg baricitinib were reassigned to receive 2 mg or 4 mg baricitinib, and nonresponders receiving 4 mg baricitinib continued their treatment.

Disclosures: This study was funded by Eli Lilly and Company, under license from Incyte Corporation. Some authors reported ties with various organizations, including Eli Lilly. Four authors declared being employees and stockholders of Eli Lilly.

Source: Silverberg JI et al. Long-term efficacy (up to 68 weeks) of baricitinib in combination with topical corticosteroids in adult patients with moderate-to-severe atopic dermatitis: Analysis of treatment responders, partial responders and nonresponders originating from study BREEZE-AD7. J Eur Acad Dermatol Venereol. 2023 (Dec 14, 2022). Doi: 10.1111/jdv.18816

Key clinical point: Patients with moderate-to-severe atopic dermatitis (AD) experienced a significantly greater reduction in itch as early as 4 days after treatment with 200 mg abrocitinib compared with dupilumab and placebo.

Major finding: At day 4 after treatment, a significantly higher proportion of patients achieved a ≥4-point improvement in Peak Pruritus Numerical Rating Scale score in the 200 mg abrocitinib group (18.6%) than in the placebo (6.0%; P < .003) and dupilumab (5.6%; P < .001) groups.

Study details: This post hoc analysis of JADE COMPARE included 837 adult patients with moderate-to-severe AD who were randomly assigned to receive oral abrocitinib (200 or 100 mg), subcutaneous dupilumab (300 mg), or placebo with medicated topical therapy for 16 weeks.

Disclosures: This study was funded by Pfizer Inc. Some authors reported ties with various organizations, including Pfizer. Six authors declared being current or former employees and shareholders of Pfizer.

Source: Ständer S et al. Early itch response with abrocitinib is associated with later efficacy outcomes in patients with moderate-to-severe atopic dermatitis: Subgroup analysis of the randomized phase III JADE COMPARE trial. Am J Clin Dermatol. 2022 (Dec 13). Doi: 10.1007/s40257-022-00738-4

Key clinical point: Patients with moderate-to-severe atopic dermatitis (AD) experienced a significantly greater reduction in itch as early as 4 days after treatment with 200 mg abrocitinib compared with dupilumab and placebo.

Major finding: At day 4 after treatment, a significantly higher proportion of patients achieved a ≥4-point improvement in Peak Pruritus Numerical Rating Scale score in the 200 mg abrocitinib group (18.6%) than in the placebo (6.0%; P < .003) and dupilumab (5.6%; P < .001) groups.

Study details: This post hoc analysis of JADE COMPARE included 837 adult patients with moderate-to-severe AD who were randomly assigned to receive oral abrocitinib (200 or 100 mg), subcutaneous dupilumab (300 mg), or placebo with medicated topical therapy for 16 weeks.

Disclosures: This study was funded by Pfizer Inc. Some authors reported ties with various organizations, including Pfizer. Six authors declared being current or former employees and shareholders of Pfizer.

Source: Ständer S et al. Early itch response with abrocitinib is associated with later efficacy outcomes in patients with moderate-to-severe atopic dermatitis: Subgroup analysis of the randomized phase III JADE COMPARE trial. Am J Clin Dermatol. 2022 (Dec 13). Doi: 10.1007/s40257-022-00738-4

Key clinical point: Patients with moderate-to-severe atopic dermatitis (AD) experienced a significantly greater reduction in itch as early as 4 days after treatment with 200 mg abrocitinib compared with dupilumab and placebo.

Major finding: At day 4 after treatment, a significantly higher proportion of patients achieved a ≥4-point improvement in Peak Pruritus Numerical Rating Scale score in the 200 mg abrocitinib group (18.6%) than in the placebo (6.0%; P < .003) and dupilumab (5.6%; P < .001) groups.

Study details: This post hoc analysis of JADE COMPARE included 837 adult patients with moderate-to-severe AD who were randomly assigned to receive oral abrocitinib (200 or 100 mg), subcutaneous dupilumab (300 mg), or placebo with medicated topical therapy for 16 weeks.

Disclosures: This study was funded by Pfizer Inc. Some authors reported ties with various organizations, including Pfizer. Six authors declared being current or former employees and shareholders of Pfizer.

Source: Ständer S et al. Early itch response with abrocitinib is associated with later efficacy outcomes in patients with moderate-to-severe atopic dermatitis: Subgroup analysis of the randomized phase III JADE COMPARE trial. Am J Clin Dermatol. 2022 (Dec 13). Doi: 10.1007/s40257-022-00738-4

Key clinical point: Compared with topical corticosteroids (TCS) alone, lebrikizumab+TCS significantly improved outcomes in patients with moderate-to-severe atopic dermatitis (AD).

Major finding: At week 16, a significantly higher proportion of patients in the lebrikizumab+TCS vs placebo+TCS group achieved an Investigator’s Global Assessment score of 0 or 1 (41.2% vs 22.1%; P  =  .01) and a 75% improvement in the Eczema Area and Severity Index (69.5% vs 42.2%; P < .001). The frequencies of patient-reported serious adverse events (AE) were similar in both groups (<2%); most treatment-emergent AE were of mild or moderate severity.

Study details: Findings are from a multicenter phase 3 study, ADhere, including 211 patients aged ≥ 12 years with moderate-to-severe AD who were randomly assigned to receive lebrikizumab+TCS (n = 145) or placebo+TCS (n = 66).

Disclosures: This study was sponsored by Dermira, Inc; a wholly-owned subsidiary of Eli Lilly and Company. Some authors reported ties with various organizations, including Eli Lilly. Six authors declared being employees or stockholders of Eli Lilly.

Source: Simpson EL et al for the ADhere Investigators. Efficacy and safety of lebrikizumab in combination with topical corticosteroids in adolescents and adults with moderate-to-severe atopic dermatitis: A randomized clinical trial (ADhere). JAMA Dermatol. 2023 (Jan 11). Doi: 10.1001/jamadermatol.2022.5534

Key clinical point: Compared with topical corticosteroids (TCS) alone, lebrikizumab+TCS significantly improved outcomes in patients with moderate-to-severe atopic dermatitis (AD).

Major finding: At week 16, a significantly higher proportion of patients in the lebrikizumab+TCS vs placebo+TCS group achieved an Investigator’s Global Assessment score of 0 or 1 (41.2% vs 22.1%; P  =  .01) and a 75% improvement in the Eczema Area and Severity Index (69.5% vs 42.2%; P < .001). The frequencies of patient-reported serious adverse events (AE) were similar in both groups (<2%); most treatment-emergent AE were of mild or moderate severity.

Study details: Findings are from a multicenter phase 3 study, ADhere, including 211 patients aged ≥ 12 years with moderate-to-severe AD who were randomly assigned to receive lebrikizumab+TCS (n = 145) or placebo+TCS (n = 66).

Disclosures: This study was sponsored by Dermira, Inc; a wholly-owned subsidiary of Eli Lilly and Company. Some authors reported ties with various organizations, including Eli Lilly. Six authors declared being employees or stockholders of Eli Lilly.

Source: Simpson EL et al for the ADhere Investigators. Efficacy and safety of lebrikizumab in combination with topical corticosteroids in adolescents and adults with moderate-to-severe atopic dermatitis: A randomized clinical trial (ADhere). JAMA Dermatol. 2023 (Jan 11). Doi: 10.1001/jamadermatol.2022.5534

Key clinical point: Compared with topical corticosteroids (TCS) alone, lebrikizumab+TCS significantly improved outcomes in patients with moderate-to-severe atopic dermatitis (AD).

Major finding: At week 16, a significantly higher proportion of patients in the lebrikizumab+TCS vs placebo+TCS group achieved an Investigator’s Global Assessment score of 0 or 1 (41.2% vs 22.1%; P  =  .01) and a 75% improvement in the Eczema Area and Severity Index (69.5% vs 42.2%; P < .001). The frequencies of patient-reported serious adverse events (AE) were similar in both groups (<2%); most treatment-emergent AE were of mild or moderate severity.

Study details: Findings are from a multicenter phase 3 study, ADhere, including 211 patients aged ≥ 12 years with moderate-to-severe AD who were randomly assigned to receive lebrikizumab+TCS (n = 145) or placebo+TCS (n = 66).

Disclosures: This study was sponsored by Dermira, Inc; a wholly-owned subsidiary of Eli Lilly and Company. Some authors reported ties with various organizations, including Eli Lilly. Six authors declared being employees or stockholders of Eli Lilly.

Source: Simpson EL et al for the ADhere Investigators. Efficacy and safety of lebrikizumab in combination with topical corticosteroids in adolescents and adults with moderate-to-severe atopic dermatitis: A randomized clinical trial (ADhere). JAMA Dermatol. 2023 (Jan 11). Doi: 10.1001/jamadermatol.2022.5534

Key clinical point: Continuous 6-month therapy with interleukin-6 receptor inhibitors (IL-6Ri) vs tumor necrosis factor inhibitors (TNFi) or Janus kinase inhibitors (JAKi) demonstrated greater improvements in hemoglobin and C-reactive protein (CRP) levels regardless of baseline levels in patients with rheumatoid arthritis (RA).

Major finding: Six months of continuous therapy with IL-6Ri vs TNFi and JAKi led to significantly greater improvements in hemoglobin levels (adjusted odds ratios for achieving normal hemoglobin levels 3.15 and 3.85, respectively; both P < .001) and greater reductions in CRP levels (P < .01) regardless of baseline levels.

Study details: The data come from an analysis of 2772 patients with RA who received continuous TNFi, IL-6Ri, or JAKi treatment for ≥6 months.

Disclosures: This study was funded by Sanofi, and the RA registry was sponsored by CorEvitas, LLC. Six authors declared being current or former employees of, consultants for, or holding shares or stocks or stock options in Sanofi or CorEvitas LLC.

Source: Padula AS et al. The effect of targeted rheumatoid arthritis therapeutics on systemic inflammation and anemia: Analysis of data from the CorEvitas RA registry. Arthritis Res Ther. 2022;24:276 (Dec 21). Doi: 10.1186/s13075-022-02955-y

Key clinical point: Continuous 6-month therapy with interleukin-6 receptor inhibitors (IL-6Ri) vs tumor necrosis factor inhibitors (TNFi) or Janus kinase inhibitors (JAKi) demonstrated greater improvements in hemoglobin and C-reactive protein (CRP) levels regardless of baseline levels in patients with rheumatoid arthritis (RA).

Major finding: Six months of continuous therapy with IL-6Ri vs TNFi and JAKi led to significantly greater improvements in hemoglobin levels (adjusted odds ratios for achieving normal hemoglobin levels 3.15 and 3.85, respectively; both P < .001) and greater reductions in CRP levels (P < .01) regardless of baseline levels.

Study details: The data come from an analysis of 2772 patients with RA who received continuous TNFi, IL-6Ri, or JAKi treatment for ≥6 months.

Disclosures: This study was funded by Sanofi, and the RA registry was sponsored by CorEvitas, LLC. Six authors declared being current or former employees of, consultants for, or holding shares or stocks or stock options in Sanofi or CorEvitas LLC.

Source: Padula AS et al. The effect of targeted rheumatoid arthritis therapeutics on systemic inflammation and anemia: Analysis of data from the CorEvitas RA registry. Arthritis Res Ther. 2022;24:276 (Dec 21). Doi: 10.1186/s13075-022-02955-y

Key clinical point: Continuous 6-month therapy with interleukin-6 receptor inhibitors (IL-6Ri) vs tumor necrosis factor inhibitors (TNFi) or Janus kinase inhibitors (JAKi) demonstrated greater improvements in hemoglobin and C-reactive protein (CRP) levels regardless of baseline levels in patients with rheumatoid arthritis (RA).

Major finding: Six months of continuous therapy with IL-6Ri vs TNFi and JAKi led to significantly greater improvements in hemoglobin levels (adjusted odds ratios for achieving normal hemoglobin levels 3.15 and 3.85, respectively; both P < .001) and greater reductions in CRP levels (P < .01) regardless of baseline levels.

Study details: The data come from an analysis of 2772 patients with RA who received continuous TNFi, IL-6Ri, or JAKi treatment for ≥6 months.

Disclosures: This study was funded by Sanofi, and the RA registry was sponsored by CorEvitas, LLC. Six authors declared being current or former employees of, consultants for, or holding shares or stocks or stock options in Sanofi or CorEvitas LLC.

Source: Padula AS et al. The effect of targeted rheumatoid arthritis therapeutics on systemic inflammation and anemia: Analysis of data from the CorEvitas RA registry. Arthritis Res Ther. 2022;24:276 (Dec 21). Doi: 10.1186/s13075-022-02955-y

Key clinical point: Subcutaneous vs intravenous infliximab demonstrated improved efficacy in patients with rheumatoid arthritis (RA) who were inadequate responders to methotrexate (methotrexate-IR).

Major finding: At week 30, subcutaneous vs intravenous infliximab led to significantly lower Disease Activity Scores in 28 joints-C-reactive protein (DAS28-CRP; mean 3.07 vs 3.58; P  =  .0001) and significantly higher proportion of patients achieving DAS28-CRP low disease activity and remission (53.3% vs 38.5%; P  =  .0062), with no significant between-group difference after the switch to subcutaneous infliximab.

Study details: This post hoc analysis of a phase 3 trial included 339 patients with active RA who were methotrexate-IR and were randomly assigned to receive subcutaneous or intravenous infliximab; patients assigned to receive intravenous infliximab switched to subcutaneous infliximab from week 30 to 54.

Disclosures: This study was supported by Celltrion Healthcare Co., Ltd. Five authors declared being full-time employees of or receiving personal fees for advisory board and speaker’s bureau and research grants from Celltrion outside this work. Several authors reported ties with other various sources.

Source: Constantin A et al. Efficacy of subcutaneous vs intravenous infliximab in rheumatoid arthritis: A post-hoc analysis of a randomised phase III trial. Rheumatology (Oxford). 2022 (Dec 19). Doi: 10.1093/rheumatology/keac689

Key clinical point: Subcutaneous vs intravenous infliximab demonstrated improved efficacy in patients with rheumatoid arthritis (RA) who were inadequate responders to methotrexate (methotrexate-IR).

Major finding: At week 30, subcutaneous vs intravenous infliximab led to significantly lower Disease Activity Scores in 28 joints-C-reactive protein (DAS28-CRP; mean 3.07 vs 3.58; P  =  .0001) and significantly higher proportion of patients achieving DAS28-CRP low disease activity and remission (53.3% vs 38.5%; P  =  .0062), with no significant between-group difference after the switch to subcutaneous infliximab.

Study details: This post hoc analysis of a phase 3 trial included 339 patients with active RA who were methotrexate-IR and were randomly assigned to receive subcutaneous or intravenous infliximab; patients assigned to receive intravenous infliximab switched to subcutaneous infliximab from week 30 to 54.

Disclosures: This study was supported by Celltrion Healthcare Co., Ltd. Five authors declared being full-time employees of or receiving personal fees for advisory board and speaker’s bureau and research grants from Celltrion outside this work. Several authors reported ties with other various sources.

Source: Constantin A et al. Efficacy of subcutaneous vs intravenous infliximab in rheumatoid arthritis: A post-hoc analysis of a randomised phase III trial. Rheumatology (Oxford). 2022 (Dec 19). Doi: 10.1093/rheumatology/keac689

Key clinical point: Subcutaneous vs intravenous infliximab demonstrated improved efficacy in patients with rheumatoid arthritis (RA) who were inadequate responders to methotrexate (methotrexate-IR).

Major finding: At week 30, subcutaneous vs intravenous infliximab led to significantly lower Disease Activity Scores in 28 joints-C-reactive protein (DAS28-CRP; mean 3.07 vs 3.58; P  =  .0001) and significantly higher proportion of patients achieving DAS28-CRP low disease activity and remission (53.3% vs 38.5%; P  =  .0062), with no significant between-group difference after the switch to subcutaneous infliximab.

Study details: This post hoc analysis of a phase 3 trial included 339 patients with active RA who were methotrexate-IR and were randomly assigned to receive subcutaneous or intravenous infliximab; patients assigned to receive intravenous infliximab switched to subcutaneous infliximab from week 30 to 54.

Disclosures: This study was supported by Celltrion Healthcare Co., Ltd. Five authors declared being full-time employees of or receiving personal fees for advisory board and speaker’s bureau and research grants from Celltrion outside this work. Several authors reported ties with other various sources.

Source: Constantin A et al. Efficacy of subcutaneous vs intravenous infliximab in rheumatoid arthritis: A post-hoc analysis of a randomised phase III trial. Rheumatology (Oxford). 2022 (Dec 19). Doi: 10.1093/rheumatology/keac689

Key clinical point: Tumor necrosis factor inhibitors (TNFi) increased the risk for septic arthritis in patients with seropositive rheumatoid arthritis (RA), with higher incidences within 1 year of initiating TNFi.

Major finding: Patients with seropositive RA treated with infliximab (adjusted hazard ratio [aHR] 2.37), etanercept (aHR 1.82), or adalimumab/golimumab (aHR 1.82; all P < .01) were prone to develop septic arthritis, with the incidence being higher within 1 year of initiating TNFi (incidence rate/1000 person-year 25.51).

Study details: This retrospective study included 145,129 patients with new-onset seropositive RA or ankylosing spondylitis, of which 1170 patients developed septic arthritis.

Disclosures: This study did not receive any specific funding. The authors declared no conflicts of interest.

Source: Kim HW et al. Incidence of septic arthritis in patients with ankylosing spondylitis and seropositive rheumatoid arthritis following TNF-inhibitor therapy. Rheumatology (Oxford). 2022 (Dec 23). Doi: 10.1093/rheumatology/keac721

Key clinical point: Tumor necrosis factor inhibitors (TNFi) increased the risk for septic arthritis in patients with seropositive rheumatoid arthritis (RA), with higher incidences within 1 year of initiating TNFi.

Major finding: Patients with seropositive RA treated with infliximab (adjusted hazard ratio [aHR] 2.37), etanercept (aHR 1.82), or adalimumab/golimumab (aHR 1.82; all P < .01) were prone to develop septic arthritis, with the incidence being higher within 1 year of initiating TNFi (incidence rate/1000 person-year 25.51).

Study details: This retrospective study included 145,129 patients with new-onset seropositive RA or ankylosing spondylitis, of which 1170 patients developed septic arthritis.

Disclosures: This study did not receive any specific funding. The authors declared no conflicts of interest.

Source: Kim HW et al. Incidence of septic arthritis in patients with ankylosing spondylitis and seropositive rheumatoid arthritis following TNF-inhibitor therapy. Rheumatology (Oxford). 2022 (Dec 23). Doi: 10.1093/rheumatology/keac721

Key clinical point: Tumor necrosis factor inhibitors (TNFi) increased the risk for septic arthritis in patients with seropositive rheumatoid arthritis (RA), with higher incidences within 1 year of initiating TNFi.

Major finding: Patients with seropositive RA treated with infliximab (adjusted hazard ratio [aHR] 2.37), etanercept (aHR 1.82), or adalimumab/golimumab (aHR 1.82; all P < .01) were prone to develop septic arthritis, with the incidence being higher within 1 year of initiating TNFi (incidence rate/1000 person-year 25.51).

Study details: This retrospective study included 145,129 patients with new-onset seropositive RA or ankylosing spondylitis, of which 1170 patients developed septic arthritis.

Disclosures: This study did not receive any specific funding. The authors declared no conflicts of interest.

Source: Kim HW et al. Incidence of septic arthritis in patients with ankylosing spondylitis and seropositive rheumatoid arthritis following TNF-inhibitor therapy. Rheumatology (Oxford). 2022 (Dec 23). Doi: 10.1093/rheumatology/keac721

Key clinical point: Cumulative local joint inflammation over time was significantly associated with radiographic joint damage progression in the same joint in patients with early rheumatoid arthritis (RA) who were treated to a target disease activity score (DAS) of ≤2.4 for 10 years.

Major finding: Cumulative joint swelling was positively associated with local joint damage progression in the same joint (β 0.14; 95% CI 0.13-0.15). Each additional visit for joint swelling increased the joint damage score by a 0.13 unit and frequency of joint swelling in same vs other joints better predicted local joint damage progression (P < .001).

Study details: This post hoc analysis of the BeSt study included 473 patients with early RA who were randomly assigned to receive sequential monotherapy, step-up combination therapy, or initial combination therapy with methotrexate with or without sulfasalazine+prednisone or infliximab, with treatment intensification every 3 months until DAS ≤2.4 was achieved.

Disclosures: The BeSt study received funding from the Dutch College of Health Insurances and others. No competing interests were declared.

Source: Heckert SL et al. Frequency of joint inflammation is associated with local joint damage progression in rheumatoid arthritis despite long-term targeted treatment. RMD Open. 2023;9(1):e002552 (Jan 6). Doi: 10.1136/rmdopen-2022-002552

Key clinical point: Cumulative local joint inflammation over time was significantly associated with radiographic joint damage progression in the same joint in patients with early rheumatoid arthritis (RA) who were treated to a target disease activity score (DAS) of ≤2.4 for 10 years.

Major finding: Cumulative joint swelling was positively associated with local joint damage progression in the same joint (β 0.14; 95% CI 0.13-0.15). Each additional visit for joint swelling increased the joint damage score by a 0.13 unit and frequency of joint swelling in same vs other joints better predicted local joint damage progression (P < .001).

Study details: This post hoc analysis of the BeSt study included 473 patients with early RA who were randomly assigned to receive sequential monotherapy, step-up combination therapy, or initial combination therapy with methotrexate with or without sulfasalazine+prednisone or infliximab, with treatment intensification every 3 months until DAS ≤2.4 was achieved.

Disclosures: The BeSt study received funding from the Dutch College of Health Insurances and others. No competing interests were declared.

Source: Heckert SL et al. Frequency of joint inflammation is associated with local joint damage progression in rheumatoid arthritis despite long-term targeted treatment. RMD Open. 2023;9(1):e002552 (Jan 6). Doi: 10.1136/rmdopen-2022-002552

Key clinical point: Cumulative local joint inflammation over time was significantly associated with radiographic joint damage progression in the same joint in patients with early rheumatoid arthritis (RA) who were treated to a target disease activity score (DAS) of ≤2.4 for 10 years.

Major finding: Cumulative joint swelling was positively associated with local joint damage progression in the same joint (β 0.14; 95% CI 0.13-0.15). Each additional visit for joint swelling increased the joint damage score by a 0.13 unit and frequency of joint swelling in same vs other joints better predicted local joint damage progression (P < .001).

Study details: This post hoc analysis of the BeSt study included 473 patients with early RA who were randomly assigned to receive sequential monotherapy, step-up combination therapy, or initial combination therapy with methotrexate with or without sulfasalazine+prednisone or infliximab, with treatment intensification every 3 months until DAS ≤2.4 was achieved.

Disclosures: The BeSt study received funding from the Dutch College of Health Insurances and others. No competing interests were declared.

Source: Heckert SL et al. Frequency of joint inflammation is associated with local joint damage progression in rheumatoid arthritis despite long-term targeted treatment. RMD Open. 2023;9(1):e002552 (Jan 6). Doi: 10.1136/rmdopen-2022-002552

Key clinical point: “Plants for Joints” (PFJ), a 16-week multidisciplinary lifestyle program based on whole food plant-based diet, physical activity, and stress management in addition to usual care, significantly improved disease activity compared with usual care alone in patients with rheumatoid arthritis (RA) and low-to-moderate disease activity.

Major finding: After 16 weeks, patients receiving PFJ vs usual care alone had a greater reduction in disease activity score of 28 joints (DAS28; mean difference −0.90; P < .0001) and were more likely to achieve DAS28 <2.60 (odds ratio [OR] 4.6) and European Alliance of Associations for Rheumatology Good Response (OR 4.3; both P < .001). No serious adverse events were reported.

Study details: This randomized controlled trial, “Plants for Joints,” included 77 patients with RA and low-to-moderate disease activity who were randomly assigned to receive PFJ intervention plus usual care or usual care alone.

Disclosures: The trial was funded by Reade (The Netherlands) and other sources. The authors declared no conflicts of interest.

Source: Walrabenstein W et al. A multidisciplinary lifestyle program for rheumatoid arthritis: The “Plants for Joints” randomized controlled trial. Rheumatology (Oxford). 2023 (Jan 6). Doi: 10.1093/rheumatology/keac693

Key clinical point: “Plants for Joints” (PFJ), a 16-week multidisciplinary lifestyle program based on whole food plant-based diet, physical activity, and stress management in addition to usual care, significantly improved disease activity compared with usual care alone in patients with rheumatoid arthritis (RA) and low-to-moderate disease activity.

Major finding: After 16 weeks, patients receiving PFJ vs usual care alone had a greater reduction in disease activity score of 28 joints (DAS28; mean difference −0.90; P < .0001) and were more likely to achieve DAS28 <2.60 (odds ratio [OR] 4.6) and European Alliance of Associations for Rheumatology Good Response (OR 4.3; both P < .001). No serious adverse events were reported.

Study details: This randomized controlled trial, “Plants for Joints,” included 77 patients with RA and low-to-moderate disease activity who were randomly assigned to receive PFJ intervention plus usual care or usual care alone.

Disclosures: The trial was funded by Reade (The Netherlands) and other sources. The authors declared no conflicts of interest.

Source: Walrabenstein W et al. A multidisciplinary lifestyle program for rheumatoid arthritis: The “Plants for Joints” randomized controlled trial. Rheumatology (Oxford). 2023 (Jan 6). Doi: 10.1093/rheumatology/keac693

Key clinical point: “Plants for Joints” (PFJ), a 16-week multidisciplinary lifestyle program based on whole food plant-based diet, physical activity, and stress management in addition to usual care, significantly improved disease activity compared with usual care alone in patients with rheumatoid arthritis (RA) and low-to-moderate disease activity.

Major finding: After 16 weeks, patients receiving PFJ vs usual care alone had a greater reduction in disease activity score of 28 joints (DAS28; mean difference −0.90; P < .0001) and were more likely to achieve DAS28 <2.60 (odds ratio [OR] 4.6) and European Alliance of Associations for Rheumatology Good Response (OR 4.3; both P < .001). No serious adverse events were reported.

Study details: This randomized controlled trial, “Plants for Joints,” included 77 patients with RA and low-to-moderate disease activity who were randomly assigned to receive PFJ intervention plus usual care or usual care alone.

Disclosures: The trial was funded by Reade (The Netherlands) and other sources. The authors declared no conflicts of interest.

Source: Walrabenstein W et al. A multidisciplinary lifestyle program for rheumatoid arthritis: The “Plants for Joints” randomized controlled trial. Rheumatology (Oxford). 2023 (Jan 6). Doi: 10.1093/rheumatology/keac693

Key clinical point: Tapering glucocorticoids to doses >2.5 mg/day was effective with no increase in the risk for flare, whereas tapering to doses ≤2.5 mg/day significantly increased the risk for flare in patients with rheumatoid arthritis (RA) receiving biologic disease-modifying antirheumatic drugs (bDMARD).

Major finding: Discontinuation of glucocorticoids (adjusted odds ratio [aOR] 1.45; 95% CI 1.13-2.24) and tapering of glucocorticoid dose to 0-2.5 mg/day (aOR 1.37; 95% CI 1.06-2.01) were significantly associated with an increased risk for flare, whereas tapering of glucocorticoid dose to >2.5 mg/day did not significantly increase the risk for flare compared with no tapering.

Study details: The data come from a case-crossover study including 508 patients with RA receiving bDMARD with or without glucocorticoids, of which 52.5% of patients reported at least one flare.

Disclosures: This study did not declare any specific funding. No conflicts of interest were declared.

Source: Adami G et al. Tapering glucocorticoids and risk of flare in rheumatoid arthritis on biological disease-modifying antirheumatic drugs (bDMARDs). RMD Open. 2023;9(1):e002792 (Jan 4). Doi: 10.1136/rmdopen-2022-002792

Key clinical point: Tapering glucocorticoids to doses >2.5 mg/day was effective with no increase in the risk for flare, whereas tapering to doses ≤2.5 mg/day significantly increased the risk for flare in patients with rheumatoid arthritis (RA) receiving biologic disease-modifying antirheumatic drugs (bDMARD).

Major finding: Discontinuation of glucocorticoids (adjusted odds ratio [aOR] 1.45; 95% CI 1.13-2.24) and tapering of glucocorticoid dose to 0-2.5 mg/day (aOR 1.37; 95% CI 1.06-2.01) were significantly associated with an increased risk for flare, whereas tapering of glucocorticoid dose to >2.5 mg/day did not significantly increase the risk for flare compared with no tapering.

Study details: The data come from a case-crossover study including 508 patients with RA receiving bDMARD with or without glucocorticoids, of which 52.5% of patients reported at least one flare.

Disclosures: This study did not declare any specific funding. No conflicts of interest were declared.

Source: Adami G et al. Tapering glucocorticoids and risk of flare in rheumatoid arthritis on biological disease-modifying antirheumatic drugs (bDMARDs). RMD Open. 2023;9(1):e002792 (Jan 4). Doi: 10.1136/rmdopen-2022-002792

Key clinical point: Tapering glucocorticoids to doses >2.5 mg/day was effective with no increase in the risk for flare, whereas tapering to doses ≤2.5 mg/day significantly increased the risk for flare in patients with rheumatoid arthritis (RA) receiving biologic disease-modifying antirheumatic drugs (bDMARD).

Major finding: Discontinuation of glucocorticoids (adjusted odds ratio [aOR] 1.45; 95% CI 1.13-2.24) and tapering of glucocorticoid dose to 0-2.5 mg/day (aOR 1.37; 95% CI 1.06-2.01) were significantly associated with an increased risk for flare, whereas tapering of glucocorticoid dose to >2.5 mg/day did not significantly increase the risk for flare compared with no tapering.

Study details: The data come from a case-crossover study including 508 patients with RA receiving bDMARD with or without glucocorticoids, of which 52.5% of patients reported at least one flare.

Disclosures: This study did not declare any specific funding. No conflicts of interest were declared.

Source: Adami G et al. Tapering glucocorticoids and risk of flare in rheumatoid arthritis on biological disease-modifying antirheumatic drugs (bDMARDs). RMD Open. 2023;9(1):e002792 (Jan 4). Doi: 10.1136/rmdopen-2022-002792

Key clinical point: Patients with rheumatoid arthritis (RA) who were males or had multiple comorbidities were less likely to achieve quality care markers, thereby highlighting the need to prioritize early treatment in the vulnerable patient population.

Major finding: Among patients with RA, males (odds ratio [OR] 0.72; 95% CI 0.72-0.73) and those with a Rheumatic Disease Comorbidity Index >2 (OR 0.88; 95% CI 0.86-0.90) were less likely to receive a rheumatologist referral, with findings being similar for annual physical examination. Additionally, the presence of diabetes was associated with reduced odds of receiving a rheumatologist referral (OR 0.77; 95% CI 0.76-0.78) or annual physical examination (OR 0.59; 95% CI 0.56-0.62).

Study details: This retrospective observational cohort study included 581,770 patients with incident RA.

Disclosures: This study was funded by joint grants from Chang Gung Memorial Hospital-University of Michigan Medical Center to two authors. KC Chung reported receiving funding, research grant, and book royalties from various sources.

Source: Seyferth AV et al. Factors associated with quality care among adults with rheumatoid arthritis. JAMA Netw Open. 2022;5(12):e2246299 (Dec 12). Doi: 10.1001/jamanetworkopen.2022.46299.

Key clinical point: Patients with rheumatoid arthritis (RA) who were males or had multiple comorbidities were less likely to achieve quality care markers, thereby highlighting the need to prioritize early treatment in the vulnerable patient population.

Major finding: Among patients with RA, males (odds ratio [OR] 0.72; 95% CI 0.72-0.73) and those with a Rheumatic Disease Comorbidity Index >2 (OR 0.88; 95% CI 0.86-0.90) were less likely to receive a rheumatologist referral, with findings being similar for annual physical examination. Additionally, the presence of diabetes was associated with reduced odds of receiving a rheumatologist referral (OR 0.77; 95% CI 0.76-0.78) or annual physical examination (OR 0.59; 95% CI 0.56-0.62).

Study details: This retrospective observational cohort study included 581,770 patients with incident RA.

Disclosures: This study was funded by joint grants from Chang Gung Memorial Hospital-University of Michigan Medical Center to two authors. KC Chung reported receiving funding, research grant, and book royalties from various sources.

Source: Seyferth AV et al. Factors associated with quality care among adults with rheumatoid arthritis. JAMA Netw Open. 2022;5(12):e2246299 (Dec 12). Doi: 10.1001/jamanetworkopen.2022.46299.

Key clinical point: Patients with rheumatoid arthritis (RA) who were males or had multiple comorbidities were less likely to achieve quality care markers, thereby highlighting the need to prioritize early treatment in the vulnerable patient population.

Major finding: Among patients with RA, males (odds ratio [OR] 0.72; 95% CI 0.72-0.73) and those with a Rheumatic Disease Comorbidity Index >2 (OR 0.88; 95% CI 0.86-0.90) were less likely to receive a rheumatologist referral, with findings being similar for annual physical examination. Additionally, the presence of diabetes was associated with reduced odds of receiving a rheumatologist referral (OR 0.77; 95% CI 0.76-0.78) or annual physical examination (OR 0.59; 95% CI 0.56-0.62).

Study details: This retrospective observational cohort study included 581,770 patients with incident RA.

Disclosures: This study was funded by joint grants from Chang Gung Memorial Hospital-University of Michigan Medical Center to two authors. KC Chung reported receiving funding, research grant, and book royalties from various sources.

Source: Seyferth AV et al. Factors associated with quality care among adults with rheumatoid arthritis. JAMA Netw Open. 2022;5(12):e2246299 (Dec 12). Doi: 10.1001/jamanetworkopen.2022.46299.