Clinical Edge Journal Scan

Key clinical point: Methotrexate dosage may be tapered from targeted therapy in patients with controlled rheumatoid arthritis (RA) but with a low risk for not being able to sustain remission for up to 18 months.

Major finding: The ability to sustain remission for up to 18 months was 10% lower in patients with RA who tapered vs did not taper methotrexate from targeted therapy (risk ratio 0.90; 95% CI 0.84-0.97).

Study details: This was a systematic review and meta-analysis of 10 studies including 2000 patients with early or established RA who received any targeted therapy in combination with methotrexate and eventually tapered their methotrexate dosage.

Disclosures: This study was supported by the Hospital for Special Surgery, New York. Some authors reported receiving grants, honoraria or consulting fees, or owning stocks in various sources.

Source: Meng CF et al. Can patients with controlled rheumatoid arthritis taper methotrexate from targeted therapy and sustain remission? A systematic review and meta-analysis. J Rheumatol. 2022 (Aug 15). Doi: 10.3899/jrheum.220152

Key clinical point: Methotrexate dosage may be tapered from targeted therapy in patients with controlled rheumatoid arthritis (RA) but with a low risk for not being able to sustain remission for up to 18 months.

Major finding: The ability to sustain remission for up to 18 months was 10% lower in patients with RA who tapered vs did not taper methotrexate from targeted therapy (risk ratio 0.90; 95% CI 0.84-0.97).

Study details: This was a systematic review and meta-analysis of 10 studies including 2000 patients with early or established RA who received any targeted therapy in combination with methotrexate and eventually tapered their methotrexate dosage.

Disclosures: This study was supported by the Hospital for Special Surgery, New York. Some authors reported receiving grants, honoraria or consulting fees, or owning stocks in various sources.

Source: Meng CF et al. Can patients with controlled rheumatoid arthritis taper methotrexate from targeted therapy and sustain remission? A systematic review and meta-analysis. J Rheumatol. 2022 (Aug 15). Doi: 10.3899/jrheum.220152

Key clinical point: Methotrexate dosage may be tapered from targeted therapy in patients with controlled rheumatoid arthritis (RA) but with a low risk for not being able to sustain remission for up to 18 months.

Major finding: The ability to sustain remission for up to 18 months was 10% lower in patients with RA who tapered vs did not taper methotrexate from targeted therapy (risk ratio 0.90; 95% CI 0.84-0.97).

Study details: This was a systematic review and meta-analysis of 10 studies including 2000 patients with early or established RA who received any targeted therapy in combination with methotrexate and eventually tapered their methotrexate dosage.

Disclosures: This study was supported by the Hospital for Special Surgery, New York. Some authors reported receiving grants, honoraria or consulting fees, or owning stocks in various sources.

Source: Meng CF et al. Can patients with controlled rheumatoid arthritis taper methotrexate from targeted therapy and sustain remission? A systematic review and meta-analysis. J Rheumatol. 2022 (Aug 15). Doi: 10.3899/jrheum.220152

Key clinical point: Real-world analysis demonstrated a higher efficacy of non-tumor necrosis factor inhibitors (non-TNFi) vs TNFi and Janus kinase inhibitors (JAKi) vs biologic disease-modifying antirheumatic drugs (bDMARD) in patients with rheumatoid arthritis (RA), along with a higher efficacy of adalimumab, etanercept, and golimumab vs infliximab within TNFi.

Major finding: Efficacies of TNFi vs non-TNFi drugs (risk ratio [RR] 0.88; P < .01) and bDMARD vs JAKi (RR 0.86; P < .01) were lower. Among TNFi, adalimumab, etanercept, and golimumab were 19.0% more effective than infliximab (RR 1.19; P < .01).

Study details: This was a systematic review and meta-analysis of 21 population-based, prospective, and retrospective cohort studies including 182,098 patients with RA.

Disclosures: This study was supported by the Secretariat of Science, Technology, Innovation, and Strategic Inputs of the Ministry of Health, Brazil, and the Oswaldo Cruz Foundation, Fiocruz. The authors declared no conflicts of interest.

Source: de Castro CT et al. Real-world effectiveness of biological therapy in patients with rheumatoid arthritis: Systematic review and meta-analysis. Front Pharmacol. 2022;13:927179  (Aug 11). Doi: 10.3389/fphar.2022.927179

Key clinical point: Real-world analysis demonstrated a higher efficacy of non-tumor necrosis factor inhibitors (non-TNFi) vs TNFi and Janus kinase inhibitors (JAKi) vs biologic disease-modifying antirheumatic drugs (bDMARD) in patients with rheumatoid arthritis (RA), along with a higher efficacy of adalimumab, etanercept, and golimumab vs infliximab within TNFi.

Major finding: Efficacies of TNFi vs non-TNFi drugs (risk ratio [RR] 0.88; P < .01) and bDMARD vs JAKi (RR 0.86; P < .01) were lower. Among TNFi, adalimumab, etanercept, and golimumab were 19.0% more effective than infliximab (RR 1.19; P < .01).

Study details: This was a systematic review and meta-analysis of 21 population-based, prospective, and retrospective cohort studies including 182,098 patients with RA.

Disclosures: This study was supported by the Secretariat of Science, Technology, Innovation, and Strategic Inputs of the Ministry of Health, Brazil, and the Oswaldo Cruz Foundation, Fiocruz. The authors declared no conflicts of interest.

Source: de Castro CT et al. Real-world effectiveness of biological therapy in patients with rheumatoid arthritis: Systematic review and meta-analysis. Front Pharmacol. 2022;13:927179  (Aug 11). Doi: 10.3389/fphar.2022.927179

Key clinical point: Real-world analysis demonstrated a higher efficacy of non-tumor necrosis factor inhibitors (non-TNFi) vs TNFi and Janus kinase inhibitors (JAKi) vs biologic disease-modifying antirheumatic drugs (bDMARD) in patients with rheumatoid arthritis (RA), along with a higher efficacy of adalimumab, etanercept, and golimumab vs infliximab within TNFi.

Major finding: Efficacies of TNFi vs non-TNFi drugs (risk ratio [RR] 0.88; P < .01) and bDMARD vs JAKi (RR 0.86; P < .01) were lower. Among TNFi, adalimumab, etanercept, and golimumab were 19.0% more effective than infliximab (RR 1.19; P < .01).

Study details: This was a systematic review and meta-analysis of 21 population-based, prospective, and retrospective cohort studies including 182,098 patients with RA.

Disclosures: This study was supported by the Secretariat of Science, Technology, Innovation, and Strategic Inputs of the Ministry of Health, Brazil, and the Oswaldo Cruz Foundation, Fiocruz. The authors declared no conflicts of interest.

Source: de Castro CT et al. Real-world effectiveness of biological therapy in patients with rheumatoid arthritis: Systematic review and meta-analysis. Front Pharmacol. 2022;13:927179  (Aug 11). Doi: 10.3389/fphar.2022.927179

Key clinical point: Patients with rheumatoid arthritis (RA) who received biologic/targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARD) were at a reduced risk for incident dementia compared with those who received conventional synthetic disease-modifying antirheumatic drugs (csDMARD) alone.

Major finding: Compared with only csDMARD use, the use of b/tsDMARD was associated with a 19% lower risk for incident dementia (adjusted hazard ratio [aHR] 0.81; 95% CI 0.76-0.87), with findings being similar for all b/tsDMARD categories: tumor necrosis factor inhibitors (TNFi; aHR 0.86; 95% CI 0.80-0.93), non-TNFi (aHR 0.76; 95% CI 0.70-0.83), and tsDMARD (aHR 0.69; 95% CI 0.53-0.90).

Study details: This was a retrospective cohort study including 141,326 patients aged ≥40 years with RA who received b/tsDMARD with or without csDMARD or csDMARD only.

Disclosures: This study was supported by a BIGDATA core grant from the US National Institutes of Health. Some authors reported receiving research support, grants, or consulting fees from various sources.

Source: Sattui SE et al. Incidence of dementia in patients with rheumatoid arthritis and association with disease modifying anti-rheumatic drugs - Analysis of a national claims database. Semin Arthritis Rheum. 2022 (Aug 17). Doi: 10.1016/j.semarthrit.2022.152083

Key clinical point: Patients with rheumatoid arthritis (RA) who received biologic/targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARD) were at a reduced risk for incident dementia compared with those who received conventional synthetic disease-modifying antirheumatic drugs (csDMARD) alone.

Major finding: Compared with only csDMARD use, the use of b/tsDMARD was associated with a 19% lower risk for incident dementia (adjusted hazard ratio [aHR] 0.81; 95% CI 0.76-0.87), with findings being similar for all b/tsDMARD categories: tumor necrosis factor inhibitors (TNFi; aHR 0.86; 95% CI 0.80-0.93), non-TNFi (aHR 0.76; 95% CI 0.70-0.83), and tsDMARD (aHR 0.69; 95% CI 0.53-0.90).

Study details: This was a retrospective cohort study including 141,326 patients aged ≥40 years with RA who received b/tsDMARD with or without csDMARD or csDMARD only.

Disclosures: This study was supported by a BIGDATA core grant from the US National Institutes of Health. Some authors reported receiving research support, grants, or consulting fees from various sources.

Source: Sattui SE et al. Incidence of dementia in patients with rheumatoid arthritis and association with disease modifying anti-rheumatic drugs - Analysis of a national claims database. Semin Arthritis Rheum. 2022 (Aug 17). Doi: 10.1016/j.semarthrit.2022.152083

Key clinical point: Patients with rheumatoid arthritis (RA) who received biologic/targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARD) were at a reduced risk for incident dementia compared with those who received conventional synthetic disease-modifying antirheumatic drugs (csDMARD) alone.

Major finding: Compared with only csDMARD use, the use of b/tsDMARD was associated with a 19% lower risk for incident dementia (adjusted hazard ratio [aHR] 0.81; 95% CI 0.76-0.87), with findings being similar for all b/tsDMARD categories: tumor necrosis factor inhibitors (TNFi; aHR 0.86; 95% CI 0.80-0.93), non-TNFi (aHR 0.76; 95% CI 0.70-0.83), and tsDMARD (aHR 0.69; 95% CI 0.53-0.90).

Study details: This was a retrospective cohort study including 141,326 patients aged ≥40 years with RA who received b/tsDMARD with or without csDMARD or csDMARD only.

Disclosures: This study was supported by a BIGDATA core grant from the US National Institutes of Health. Some authors reported receiving research support, grants, or consulting fees from various sources.

Source: Sattui SE et al. Incidence of dementia in patients with rheumatoid arthritis and association with disease modifying anti-rheumatic drugs - Analysis of a national claims database. Semin Arthritis Rheum. 2022 (Aug 17). Doi: 10.1016/j.semarthrit.2022.152083

Key clinical point: Iguratimod as monotherapy or in combination with methotrexate showed clear benefits over methotrexate in improving disease activity in patients with rheumatoid arthritis (RA) along with a comparable safety profile.

Major finding: Compared with methotrexate monotherapy, iguratimod monotherapy and iguratimod+methotrexate therapy were associated with more effective improvements in the American College of Rheumatology 20% improvement response rate (risk ratio [RR] 1.15; P  =  .004; and RR 1.24; P < .00001, respectively) and 28-joint Disease Activity Score based on erythrocyte sedimentation rate (mean difference [MD] −0.15; P  =  .01; and MD −1.43; P < .00001, respectively) with a similar incidence of adverse events.

Study details: Findings are from a systematic review and meta-analysis of 38 randomized controlled trials including 4302 patients with RA who received iguratimod alone, iguratimod with methotrexate, methotrexate alone, or methotrexate with leflunomide or hydroxychloroquine or tripterygium glycosides.

Disclosures: This study was supported by the National Youth Science Foundation of China and Research Fund of Hunan Province Education Department. The authors declared no conflicts of interest.

Source: Ouyang D et al. Effectiveness and safety of iguratimod monotherapy or combined with methotrexate in treating rheumatoid arthritis: A systematic review and meta-analysis. Front Pharmacol. 2022;13:911810 (Aug 5). Doi: 10.3389/fphar.2022.911810

Key clinical point: Iguratimod as monotherapy or in combination with methotrexate showed clear benefits over methotrexate in improving disease activity in patients with rheumatoid arthritis (RA) along with a comparable safety profile.

Major finding: Compared with methotrexate monotherapy, iguratimod monotherapy and iguratimod+methotrexate therapy were associated with more effective improvements in the American College of Rheumatology 20% improvement response rate (risk ratio [RR] 1.15; P  =  .004; and RR 1.24; P < .00001, respectively) and 28-joint Disease Activity Score based on erythrocyte sedimentation rate (mean difference [MD] −0.15; P  =  .01; and MD −1.43; P < .00001, respectively) with a similar incidence of adverse events.

Study details: Findings are from a systematic review and meta-analysis of 38 randomized controlled trials including 4302 patients with RA who received iguratimod alone, iguratimod with methotrexate, methotrexate alone, or methotrexate with leflunomide or hydroxychloroquine or tripterygium glycosides.

Disclosures: This study was supported by the National Youth Science Foundation of China and Research Fund of Hunan Province Education Department. The authors declared no conflicts of interest.

Source: Ouyang D et al. Effectiveness and safety of iguratimod monotherapy or combined with methotrexate in treating rheumatoid arthritis: A systematic review and meta-analysis. Front Pharmacol. 2022;13:911810 (Aug 5). Doi: 10.3389/fphar.2022.911810

Key clinical point: Iguratimod as monotherapy or in combination with methotrexate showed clear benefits over methotrexate in improving disease activity in patients with rheumatoid arthritis (RA) along with a comparable safety profile.

Major finding: Compared with methotrexate monotherapy, iguratimod monotherapy and iguratimod+methotrexate therapy were associated with more effective improvements in the American College of Rheumatology 20% improvement response rate (risk ratio [RR] 1.15; P  =  .004; and RR 1.24; P < .00001, respectively) and 28-joint Disease Activity Score based on erythrocyte sedimentation rate (mean difference [MD] −0.15; P  =  .01; and MD −1.43; P < .00001, respectively) with a similar incidence of adverse events.

Study details: Findings are from a systematic review and meta-analysis of 38 randomized controlled trials including 4302 patients with RA who received iguratimod alone, iguratimod with methotrexate, methotrexate alone, or methotrexate with leflunomide or hydroxychloroquine or tripterygium glycosides.

Disclosures: This study was supported by the National Youth Science Foundation of China and Research Fund of Hunan Province Education Department. The authors declared no conflicts of interest.

Source: Ouyang D et al. Effectiveness and safety of iguratimod monotherapy or combined with methotrexate in treating rheumatoid arthritis: A systematic review and meta-analysis. Front Pharmacol. 2022;13:911810 (Aug 5). Doi: 10.3389/fphar.2022.911810

Key clinical point: Individual tapering of disease-modifying antirheumatic drugs (DMARD) might be feasible in patients with rheumatoid arthritis (RA) in sustained remission for more than 6 months.

Major finding: The risks for flare (adjusted hazard ratio [aHR] 0.88; 95% CI 0.59-1.30) and loss of remission (aHR 1.04; 95% CI 0.73-1.49) were not significantly different among patients who tapered vs continued DMARD. The clinical disease activity index showed a minor and nonsignificant increase at 12 months in patients who tapered vs continued DMARD (1.80 vs 0.91 units; P  =  .076).

Study details: Findings are from an analysis of a prospective cohort of 437 patients with RA in sustained remission for ≥6 months who either tapered or continued DMARD.

Disclosures: This study was supported by the Federal Joint Committee, Germany. All authors reported receiving grants from the Federal Joint Committee. E Edelmann reported receiving personal fees from various sources. F Verheyen contributed as an employee of Techniker Krankenkasse.

Source: Birkner B et al. Patient-individual tapering of DMARDs in rheumatoid arthritis patients in a real-world setting. Rheumatology (Oxford). 2022 (Aug 18). Doi:  10.1093/rheumatology/keac472

Key clinical point: Individual tapering of disease-modifying antirheumatic drugs (DMARD) might be feasible in patients with rheumatoid arthritis (RA) in sustained remission for more than 6 months.

Major finding: The risks for flare (adjusted hazard ratio [aHR] 0.88; 95% CI 0.59-1.30) and loss of remission (aHR 1.04; 95% CI 0.73-1.49) were not significantly different among patients who tapered vs continued DMARD. The clinical disease activity index showed a minor and nonsignificant increase at 12 months in patients who tapered vs continued DMARD (1.80 vs 0.91 units; P  =  .076).

Study details: Findings are from an analysis of a prospective cohort of 437 patients with RA in sustained remission for ≥6 months who either tapered or continued DMARD.

Disclosures: This study was supported by the Federal Joint Committee, Germany. All authors reported receiving grants from the Federal Joint Committee. E Edelmann reported receiving personal fees from various sources. F Verheyen contributed as an employee of Techniker Krankenkasse.

Source: Birkner B et al. Patient-individual tapering of DMARDs in rheumatoid arthritis patients in a real-world setting. Rheumatology (Oxford). 2022 (Aug 18). Doi:  10.1093/rheumatology/keac472

Key clinical point: Individual tapering of disease-modifying antirheumatic drugs (DMARD) might be feasible in patients with rheumatoid arthritis (RA) in sustained remission for more than 6 months.

Major finding: The risks for flare (adjusted hazard ratio [aHR] 0.88; 95% CI 0.59-1.30) and loss of remission (aHR 1.04; 95% CI 0.73-1.49) were not significantly different among patients who tapered vs continued DMARD. The clinical disease activity index showed a minor and nonsignificant increase at 12 months in patients who tapered vs continued DMARD (1.80 vs 0.91 units; P  =  .076).

Study details: Findings are from an analysis of a prospective cohort of 437 patients with RA in sustained remission for ≥6 months who either tapered or continued DMARD.

Disclosures: This study was supported by the Federal Joint Committee, Germany. All authors reported receiving grants from the Federal Joint Committee. E Edelmann reported receiving personal fees from various sources. F Verheyen contributed as an employee of Techniker Krankenkasse.

Source: Birkner B et al. Patient-individual tapering of DMARDs in rheumatoid arthritis patients in a real-world setting. Rheumatology (Oxford). 2022 (Aug 18). Doi:  10.1093/rheumatology/keac472

Key clinical point: Patients with rheumatoid arthritis (RA) and an inadequate response to methotrexate (methotrexate-IR) who initiated upadacitinib vs adalimumab spent a longer time in improved disease states and reported faster achievement of treatment targets.

Major finding: Patients initially receiving upadacitinib vs adalimumab spent 19% vs 14% of the time over 48 weeks in clinical disease activity index remission (nominal P  =  .012) and achieved the 28-joint disease activity score using C-reactive protein of <2.6/≤3.2 approximately 6-8 weeks (median time) earlier.

Study details: Findings are from a post hoc analysis including patients with RA and methotrexate-IR from the phase 3 SELECT-COMPARE trial who were randomly assigned to receive upadacitinib (n = 651) or adalimumab (n = 327) with background methotrexate.

Disclosures: The trial was funded by AbbVie, Inc. Five authors declared being employees of and may own stocks or options in AbbVie. The other authors reported ties with various sources, including AbbVie.

Source: Mysler E et al. Impact of initial therapy with upadacitinib or adalimumab on achievement of 48-week treatment goals in patients with rheumatoid arthritis: Post hoc analysis of SELECT-COMPARE. Rheumatology (Oxford). 2022 (Aug 26). Doi:  10.1093/rheumatology/keac477

Key clinical point: Patients with rheumatoid arthritis (RA) and an inadequate response to methotrexate (methotrexate-IR) who initiated upadacitinib vs adalimumab spent a longer time in improved disease states and reported faster achievement of treatment targets.

Major finding: Patients initially receiving upadacitinib vs adalimumab spent 19% vs 14% of the time over 48 weeks in clinical disease activity index remission (nominal P  =  .012) and achieved the 28-joint disease activity score using C-reactive protein of <2.6/≤3.2 approximately 6-8 weeks (median time) earlier.

Study details: Findings are from a post hoc analysis including patients with RA and methotrexate-IR from the phase 3 SELECT-COMPARE trial who were randomly assigned to receive upadacitinib (n = 651) or adalimumab (n = 327) with background methotrexate.

Disclosures: The trial was funded by AbbVie, Inc. Five authors declared being employees of and may own stocks or options in AbbVie. The other authors reported ties with various sources, including AbbVie.

Source: Mysler E et al. Impact of initial therapy with upadacitinib or adalimumab on achievement of 48-week treatment goals in patients with rheumatoid arthritis: Post hoc analysis of SELECT-COMPARE. Rheumatology (Oxford). 2022 (Aug 26). Doi:  10.1093/rheumatology/keac477

Key clinical point: Patients with rheumatoid arthritis (RA) and an inadequate response to methotrexate (methotrexate-IR) who initiated upadacitinib vs adalimumab spent a longer time in improved disease states and reported faster achievement of treatment targets.

Major finding: Patients initially receiving upadacitinib vs adalimumab spent 19% vs 14% of the time over 48 weeks in clinical disease activity index remission (nominal P  =  .012) and achieved the 28-joint disease activity score using C-reactive protein of <2.6/≤3.2 approximately 6-8 weeks (median time) earlier.

Study details: Findings are from a post hoc analysis including patients with RA and methotrexate-IR from the phase 3 SELECT-COMPARE trial who were randomly assigned to receive upadacitinib (n = 651) or adalimumab (n = 327) with background methotrexate.

Disclosures: The trial was funded by AbbVie, Inc. Five authors declared being employees of and may own stocks or options in AbbVie. The other authors reported ties with various sources, including AbbVie.

Source: Mysler E et al. Impact of initial therapy with upadacitinib or adalimumab on achievement of 48-week treatment goals in patients with rheumatoid arthritis: Post hoc analysis of SELECT-COMPARE. Rheumatology (Oxford). 2022 (Aug 26). Doi:  10.1093/rheumatology/keac477

Key clinical point: Patients with rheumatoid arthritis-associated interstitial lung disease (RA-ILD) were at an increased risk for mortality, with age, chronic obstructive pulmonary disease (COPD), diabetes mellitus with end-organ damage (DM-EOD), and corticosteroid dose being the major risk factors.

Major finding: Risk for mortality was higher in patients with RA-ILD vs RA without ILD (adjusted hazard ratio [aHR] 4.38; 95% CI 2.03-9.43). Age at ILD diagnosis (aHR 1.05; P < .001), comorbidities, such as COPD (aHR 2.12; P  =  .005) and DM-EOD (aHR 33.85; P  =  .002), and average daily prednisolone dose (aHR 1.09; P < .001) were associated with an increased risk for mortality in patients with RA-ILD.

Study details: Findings are from a population-based cohort study including patients with RA-ILD (n = 214) and RA without ILD (n = 30,882) who were propensity-matched (1:1) for selected comorbidities.

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

Source: Ng K-H et al. Analysis of risk factors of mortality in rheumatoid arthritis patients with interstitial lung disease: A nationwide, population-based cohort study in Taiwan. RMD Open. 2022;8(2):e002343 (Aug 22). Doi: 10.1136/rmdopen-2022-002343

Key clinical point: Patients with rheumatoid arthritis-associated interstitial lung disease (RA-ILD) were at an increased risk for mortality, with age, chronic obstructive pulmonary disease (COPD), diabetes mellitus with end-organ damage (DM-EOD), and corticosteroid dose being the major risk factors.

Major finding: Risk for mortality was higher in patients with RA-ILD vs RA without ILD (adjusted hazard ratio [aHR] 4.38; 95% CI 2.03-9.43). Age at ILD diagnosis (aHR 1.05; P < .001), comorbidities, such as COPD (aHR 2.12; P  =  .005) and DM-EOD (aHR 33.85; P  =  .002), and average daily prednisolone dose (aHR 1.09; P < .001) were associated with an increased risk for mortality in patients with RA-ILD.

Study details: Findings are from a population-based cohort study including patients with RA-ILD (n = 214) and RA without ILD (n = 30,882) who were propensity-matched (1:1) for selected comorbidities.

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

Source: Ng K-H et al. Analysis of risk factors of mortality in rheumatoid arthritis patients with interstitial lung disease: A nationwide, population-based cohort study in Taiwan. RMD Open. 2022;8(2):e002343 (Aug 22). Doi: 10.1136/rmdopen-2022-002343

Key clinical point: Patients with rheumatoid arthritis-associated interstitial lung disease (RA-ILD) were at an increased risk for mortality, with age, chronic obstructive pulmonary disease (COPD), diabetes mellitus with end-organ damage (DM-EOD), and corticosteroid dose being the major risk factors.

Major finding: Risk for mortality was higher in patients with RA-ILD vs RA without ILD (adjusted hazard ratio [aHR] 4.38; 95% CI 2.03-9.43). Age at ILD diagnosis (aHR 1.05; P < .001), comorbidities, such as COPD (aHR 2.12; P  =  .005) and DM-EOD (aHR 33.85; P  =  .002), and average daily prednisolone dose (aHR 1.09; P < .001) were associated with an increased risk for mortality in patients with RA-ILD.

Study details: Findings are from a population-based cohort study including patients with RA-ILD (n = 214) and RA without ILD (n = 30,882) who were propensity-matched (1:1) for selected comorbidities.

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

Source: Ng K-H et al. Analysis of risk factors of mortality in rheumatoid arthritis patients with interstitial lung disease: A nationwide, population-based cohort study in Taiwan. RMD Open. 2022;8(2):e002343 (Aug 22). Doi: 10.1136/rmdopen-2022-002343

Key clinical point: Ultra-low dosing and repeated COVID-19 vaccination as late as possible after the latest rituximab infusion seems to be the best vaccination strategy in rituximab-treated patients with rheumatoid arthritis (RA).

Major finding: Humoral response after the third COVID-19 vaccination was numerically higher with 200 vs 1000 mg as the latest rituximab dose for the first vaccination (38% vs 15%; P  =  .06), with a trend toward improved response observed with a longer time between rituximab infusion and vaccination (odds ratio 1.16 per month increased time; P  =  .10). Overall, the humoral response persisted in 96% of patients, with response being persistent in 89% of patients despite intercurrent rituximab infusion.

Study details: Findings are from a follow-up study of the RTX-COVAC cohort including 121 rituximab-treated patients with RA who received a third COVID-19 vaccination.

Disclosures: This study did not receive any funding. AA den Broeder reported receiving grants outside the submitted work from various sources. The other authors declared no conflicts of interest.

Source: van der Togt CJT et al. Seroconversion after a third COVID-19 vaccine is affected by rituximab dose but persistence is not in patients with rheumatoid arthritis. Rheumatology (Oxford). 2022 (Aug 24). Doi: 10.1093/rheumatology/keac486

Key clinical point: Ultra-low dosing and repeated COVID-19 vaccination as late as possible after the latest rituximab infusion seems to be the best vaccination strategy in rituximab-treated patients with rheumatoid arthritis (RA).

Major finding: Humoral response after the third COVID-19 vaccination was numerically higher with 200 vs 1000 mg as the latest rituximab dose for the first vaccination (38% vs 15%; P  =  .06), with a trend toward improved response observed with a longer time between rituximab infusion and vaccination (odds ratio 1.16 per month increased time; P  =  .10). Overall, the humoral response persisted in 96% of patients, with response being persistent in 89% of patients despite intercurrent rituximab infusion.

Study details: Findings are from a follow-up study of the RTX-COVAC cohort including 121 rituximab-treated patients with RA who received a third COVID-19 vaccination.

Disclosures: This study did not receive any funding. AA den Broeder reported receiving grants outside the submitted work from various sources. The other authors declared no conflicts of interest.

Source: van der Togt CJT et al. Seroconversion after a third COVID-19 vaccine is affected by rituximab dose but persistence is not in patients with rheumatoid arthritis. Rheumatology (Oxford). 2022 (Aug 24). Doi: 10.1093/rheumatology/keac486

Key clinical point: Ultra-low dosing and repeated COVID-19 vaccination as late as possible after the latest rituximab infusion seems to be the best vaccination strategy in rituximab-treated patients with rheumatoid arthritis (RA).

Major finding: Humoral response after the third COVID-19 vaccination was numerically higher with 200 vs 1000 mg as the latest rituximab dose for the first vaccination (38% vs 15%; P  =  .06), with a trend toward improved response observed with a longer time between rituximab infusion and vaccination (odds ratio 1.16 per month increased time; P  =  .10). Overall, the humoral response persisted in 96% of patients, with response being persistent in 89% of patients despite intercurrent rituximab infusion.

Study details: Findings are from a follow-up study of the RTX-COVAC cohort including 121 rituximab-treated patients with RA who received a third COVID-19 vaccination.

Disclosures: This study did not receive any funding. AA den Broeder reported receiving grants outside the submitted work from various sources. The other authors declared no conflicts of interest.

Source: van der Togt CJT et al. Seroconversion after a third COVID-19 vaccine is affected by rituximab dose but persistence is not in patients with rheumatoid arthritis. Rheumatology (Oxford). 2022 (Aug 24). Doi: 10.1093/rheumatology/keac486

Key clinical point: Despite no significant treatment difference between the sexes, the time-averaged difference in remission rates between men and women with early rheumatoid arthritis (RA) was significantly greater with tocilizumab than with active conventional treatment.

Major finding: The remission rates were only numerically higher in men vs women. However, when averaged over time, tocilizumab vs active conventional therapy was associated with a higher probability of Clinical Disease Activity Index (CDAI) remission in men (risk difference [RD] 0.12; P  =  .04) but with a lower probability of CDAI remission in women (RD −0.05; P  =  .17).

Study details: This was a post hoc analysis of the phase 4 trial, NORD-STAR, including 812 treatment-naive patients with early RA who were randomly assigned to receive active conventional treatment or certolizumab-pegol or abatacept or tocilizumab in combination with methotrexate.

Disclosures: This study did not receive any funding. Several authors reported receiving institutional grants, honoraria, consulting or personal fees, travel support, or personal data safety monitoring or advisory board fees from various sources.

Source: Lend K et al. Sex differences in remission rates over 24 weeks among three different biological treatments compared to conventional therapy in patients with early rheumatoid arthritis (NORD-STAR): A post-hoc analysis of a randomised controlled trial. Lancet Rheumatol. 2022 (Aug 23). Doi: 10.1016/S2665-9913(22)00186-2

Key clinical point: Despite no significant treatment difference between the sexes, the time-averaged difference in remission rates between men and women with early rheumatoid arthritis (RA) was significantly greater with tocilizumab than with active conventional treatment.

Major finding: The remission rates were only numerically higher in men vs women. However, when averaged over time, tocilizumab vs active conventional therapy was associated with a higher probability of Clinical Disease Activity Index (CDAI) remission in men (risk difference [RD] 0.12; P  =  .04) but with a lower probability of CDAI remission in women (RD −0.05; P  =  .17).

Study details: This was a post hoc analysis of the phase 4 trial, NORD-STAR, including 812 treatment-naive patients with early RA who were randomly assigned to receive active conventional treatment or certolizumab-pegol or abatacept or tocilizumab in combination with methotrexate.

Disclosures: This study did not receive any funding. Several authors reported receiving institutional grants, honoraria, consulting or personal fees, travel support, or personal data safety monitoring or advisory board fees from various sources.

Source: Lend K et al. Sex differences in remission rates over 24 weeks among three different biological treatments compared to conventional therapy in patients with early rheumatoid arthritis (NORD-STAR): A post-hoc analysis of a randomised controlled trial. Lancet Rheumatol. 2022 (Aug 23). Doi: 10.1016/S2665-9913(22)00186-2

Key clinical point: Despite no significant treatment difference between the sexes, the time-averaged difference in remission rates between men and women with early rheumatoid arthritis (RA) was significantly greater with tocilizumab than with active conventional treatment.

Major finding: The remission rates were only numerically higher in men vs women. However, when averaged over time, tocilizumab vs active conventional therapy was associated with a higher probability of Clinical Disease Activity Index (CDAI) remission in men (risk difference [RD] 0.12; P  =  .04) but with a lower probability of CDAI remission in women (RD −0.05; P  =  .17).

Study details: This was a post hoc analysis of the phase 4 trial, NORD-STAR, including 812 treatment-naive patients with early RA who were randomly assigned to receive active conventional treatment or certolizumab-pegol or abatacept or tocilizumab in combination with methotrexate.

Disclosures: This study did not receive any funding. Several authors reported receiving institutional grants, honoraria, consulting or personal fees, travel support, or personal data safety monitoring or advisory board fees from various sources.

Source: Lend K et al. Sex differences in remission rates over 24 weeks among three different biological treatments compared to conventional therapy in patients with early rheumatoid arthritis (NORD-STAR): A post-hoc analysis of a randomised controlled trial. Lancet Rheumatol. 2022 (Aug 23). Doi: 10.1016/S2665-9913(22)00186-2

Key clinical point: In patients with rheumatoid arthritis (RA) and inadequate response to methotrexate (methotrexate-IR), olokizumab fared better than placebo and was noninferior to adalimumab in improving the American College of Rheumatology (ACR20) response by ≥ 20%.

Major finding: Olokizumab once every 2 (q2w) or 4 weeks (q4w) was superior to placebo (P < .001 for superiority) for ACR20. However, a similar proportion of patients receiving olokizumab q2w (difference 3.4 percentage points; 97.5% CI −3.5 to 10.2) and q4w (difference 4.5 percentage points; 97.5% CI −2.2 to 11.2) vs adalimumab achieved ACR20 at week 12, with the incidence of serious adverse events being similar.

Study details: Findings are from the CREDO2  phase 3 trial, including 1648 patients with RA who were taking methotrexate-IR who were randomly assigned to receive 64 mg olokizumab (q2w/q4w), 40 mg adalimumab (q2w), or placebo (q2w) while continuing methotrexate.

Disclosures: This study was supported by R-Pharm. Three authors declared being employees of R-Pharm. Several authors served as consultants or received grants or contracts from various sources, including R-Pharm.

Source: Smolen JS et al. Olokizumab versus placebo or adalimumab in rheumatoid arthritis. N Engl J Med. 2022;387(8):715-726 (Aug 25). Doi: 10.1056/NEJMoa2201302

Key clinical point: In patients with rheumatoid arthritis (RA) and inadequate response to methotrexate (methotrexate-IR), olokizumab fared better than placebo and was noninferior to adalimumab in improving the American College of Rheumatology (ACR20) response by ≥ 20%.

Major finding: Olokizumab once every 2 (q2w) or 4 weeks (q4w) was superior to placebo (P < .001 for superiority) for ACR20. However, a similar proportion of patients receiving olokizumab q2w (difference 3.4 percentage points; 97.5% CI −3.5 to 10.2) and q4w (difference 4.5 percentage points; 97.5% CI −2.2 to 11.2) vs adalimumab achieved ACR20 at week 12, with the incidence of serious adverse events being similar.

Study details: Findings are from the CREDO2  phase 3 trial, including 1648 patients with RA who were taking methotrexate-IR who were randomly assigned to receive 64 mg olokizumab (q2w/q4w), 40 mg adalimumab (q2w), or placebo (q2w) while continuing methotrexate.

Disclosures: This study was supported by R-Pharm. Three authors declared being employees of R-Pharm. Several authors served as consultants or received grants or contracts from various sources, including R-Pharm.

Source: Smolen JS et al. Olokizumab versus placebo or adalimumab in rheumatoid arthritis. N Engl J Med. 2022;387(8):715-726 (Aug 25). Doi: 10.1056/NEJMoa2201302

Key clinical point: In patients with rheumatoid arthritis (RA) and inadequate response to methotrexate (methotrexate-IR), olokizumab fared better than placebo and was noninferior to adalimumab in improving the American College of Rheumatology (ACR20) response by ≥ 20%.

Major finding: Olokizumab once every 2 (q2w) or 4 weeks (q4w) was superior to placebo (P < .001 for superiority) for ACR20. However, a similar proportion of patients receiving olokizumab q2w (difference 3.4 percentage points; 97.5% CI −3.5 to 10.2) and q4w (difference 4.5 percentage points; 97.5% CI −2.2 to 11.2) vs adalimumab achieved ACR20 at week 12, with the incidence of serious adverse events being similar.

Study details: Findings are from the CREDO2  phase 3 trial, including 1648 patients with RA who were taking methotrexate-IR who were randomly assigned to receive 64 mg olokizumab (q2w/q4w), 40 mg adalimumab (q2w), or placebo (q2w) while continuing methotrexate.

Disclosures: This study was supported by R-Pharm. Three authors declared being employees of R-Pharm. Several authors served as consultants or received grants or contracts from various sources, including R-Pharm.

Source: Smolen JS et al. Olokizumab versus placebo or adalimumab in rheumatoid arthritis. N Engl J Med. 2022;387(8):715-726 (Aug 25). Doi: 10.1056/NEJMoa2201302