Rheumatoid Arthritis

Key clinical point: In patients with rheumatoid arthritis (RA) in clinical remission, treat-to-target-based treatment escalations to biologics were more effective than escalation to conventional synthetic disease-modifying antirheumatic drugs (csDMARD) in improving magnetic resonance imaging (MRI) inflammation, physical function, and clinical disease activity.

Major finding: Escalation to first biologic vs. csDMARD escalation effectively reduced MRI osteitis (difference between least squares means [∆LSM] 1.8; 95% CI 1.0-2.6), Health Assessment Questionnaire score (∆LSM 0.08; 95% CI 0.03-0.1), MRI combined inflammation (∆LSM 2.5; 95% CI 0.9-4.1), and Simplified Disease Activity Index scores (∆LSM 2.7; 95% CI 1.9-3.5).

Study details: This study evaluated the impact of treatment intensification with csDMARDs and biologics in 100 patients with established RA in clinical remission from the IMAGINE-RA trial, who were randomly assigned to MRI treat-to-target strategy.

Disclosures: This research was funded by AbbVie. Some of the authors reported receiving grants and personal fees from various sources including AbbVie.

Source: Møller-Bisgaard S et al. Scand J Rheumatol. 2021 Sep 2. doi: 10.1080/03009742.2021.1935312.

Key clinical point: In patients with rheumatoid arthritis (RA) in clinical remission, treat-to-target-based treatment escalations to biologics were more effective than escalation to conventional synthetic disease-modifying antirheumatic drugs (csDMARD) in improving magnetic resonance imaging (MRI) inflammation, physical function, and clinical disease activity.

Major finding: Escalation to first biologic vs. csDMARD escalation effectively reduced MRI osteitis (difference between least squares means [∆LSM] 1.8; 95% CI 1.0-2.6), Health Assessment Questionnaire score (∆LSM 0.08; 95% CI 0.03-0.1), MRI combined inflammation (∆LSM 2.5; 95% CI 0.9-4.1), and Simplified Disease Activity Index scores (∆LSM 2.7; 95% CI 1.9-3.5).

Study details: This study evaluated the impact of treatment intensification with csDMARDs and biologics in 100 patients with established RA in clinical remission from the IMAGINE-RA trial, who were randomly assigned to MRI treat-to-target strategy.

Disclosures: This research was funded by AbbVie. Some of the authors reported receiving grants and personal fees from various sources including AbbVie.

Source: Møller-Bisgaard S et al. Scand J Rheumatol. 2021 Sep 2. doi: 10.1080/03009742.2021.1935312.

Key clinical point: In patients with rheumatoid arthritis (RA) in clinical remission, treat-to-target-based treatment escalations to biologics were more effective than escalation to conventional synthetic disease-modifying antirheumatic drugs (csDMARD) in improving magnetic resonance imaging (MRI) inflammation, physical function, and clinical disease activity.

Major finding: Escalation to first biologic vs. csDMARD escalation effectively reduced MRI osteitis (difference between least squares means [∆LSM] 1.8; 95% CI 1.0-2.6), Health Assessment Questionnaire score (∆LSM 0.08; 95% CI 0.03-0.1), MRI combined inflammation (∆LSM 2.5; 95% CI 0.9-4.1), and Simplified Disease Activity Index scores (∆LSM 2.7; 95% CI 1.9-3.5).

Study details: This study evaluated the impact of treatment intensification with csDMARDs and biologics in 100 patients with established RA in clinical remission from the IMAGINE-RA trial, who were randomly assigned to MRI treat-to-target strategy.

Disclosures: This research was funded by AbbVie. Some of the authors reported receiving grants and personal fees from various sources including AbbVie.

Source: Møller-Bisgaard S et al. Scand J Rheumatol. 2021 Sep 2. doi: 10.1080/03009742.2021.1935312.

Key clinical point: Abatacept appeared to be more efficacious and safer than adding or switching to conventional synthetic disease-modifying antirheumatic drugs (csDMARD) in patients with rheumatoid arthritis (RA) of any age who were refractory to csDMARDs.

Major finding: At 24 weeks, European League Against Rheumatism good or moderate response was achieved by a significantly higher proportion of older patients aged 65 years or above (odds ratio [OR] 7.770; P < .0001) and younger patients (OR 4.089; P = .005) receiving abatacept vs. csDMARDs. Few serious adverse events were reported.

Study details: This was a prospective, multicenter study involving 202 bio-naive, csDMARD-refractory patients with RA. The patients were categorized into older (n=67) and younger (n=47) patients receiving abatacept and older (n=48) and younger (n=40) patients receiving csDMARDs.

Disclosures: This study was supported by Bristol Myers Squibb K.K. and Ono Pharmaceutical Co., Ltd. The authors including the lead author reported receiving grants and personal/consultancy/speakers’ fees from various sources including Bristol Myers Squibb K.K. and Ono Pharmaceutical Co., Ltd.

Source: Muraoka S et al. Rheumatol Ther. 2021 Aug 26. doi: 10.1007/s40744-021-00356-2.

Key clinical point: Abatacept appeared to be more efficacious and safer than adding or switching to conventional synthetic disease-modifying antirheumatic drugs (csDMARD) in patients with rheumatoid arthritis (RA) of any age who were refractory to csDMARDs.

Major finding: At 24 weeks, European League Against Rheumatism good or moderate response was achieved by a significantly higher proportion of older patients aged 65 years or above (odds ratio [OR] 7.770; P < .0001) and younger patients (OR 4.089; P = .005) receiving abatacept vs. csDMARDs. Few serious adverse events were reported.

Study details: This was a prospective, multicenter study involving 202 bio-naive, csDMARD-refractory patients with RA. The patients were categorized into older (n=67) and younger (n=47) patients receiving abatacept and older (n=48) and younger (n=40) patients receiving csDMARDs.

Disclosures: This study was supported by Bristol Myers Squibb K.K. and Ono Pharmaceutical Co., Ltd. The authors including the lead author reported receiving grants and personal/consultancy/speakers’ fees from various sources including Bristol Myers Squibb K.K. and Ono Pharmaceutical Co., Ltd.

Source: Muraoka S et al. Rheumatol Ther. 2021 Aug 26. doi: 10.1007/s40744-021-00356-2.

Key clinical point: Abatacept appeared to be more efficacious and safer than adding or switching to conventional synthetic disease-modifying antirheumatic drugs (csDMARD) in patients with rheumatoid arthritis (RA) of any age who were refractory to csDMARDs.

Major finding: At 24 weeks, European League Against Rheumatism good or moderate response was achieved by a significantly higher proportion of older patients aged 65 years or above (odds ratio [OR] 7.770; P < .0001) and younger patients (OR 4.089; P = .005) receiving abatacept vs. csDMARDs. Few serious adverse events were reported.

Study details: This was a prospective, multicenter study involving 202 bio-naive, csDMARD-refractory patients with RA. The patients were categorized into older (n=67) and younger (n=47) patients receiving abatacept and older (n=48) and younger (n=40) patients receiving csDMARDs.

Disclosures: This study was supported by Bristol Myers Squibb K.K. and Ono Pharmaceutical Co., Ltd. The authors including the lead author reported receiving grants and personal/consultancy/speakers’ fees from various sources including Bristol Myers Squibb K.K. and Ono Pharmaceutical Co., Ltd.

Source: Muraoka S et al. Rheumatol Ther. 2021 Aug 26. doi: 10.1007/s40744-021-00356-2.

Key clinical point: The incidence of rheumatoid arthritis-related bronchiectasis (RA-BR) was almost 20%, suggesting that bronchiectasis is a common extra-articular feature of rheumatoid arthritis (RA).

Major finding: The pooled overall prevalence of RA-BR was 18.7% (95% CI 13.7%-24.3%) in the random effects meta-analysis and 22.6% (95% CI 16.8%-29.0%) in studies that used high-resolution chest computed tomography imaging.

Study details: Findings are from a systematic review and meta-analysis of 41 studies that reported on RA-BR prevalence, risk factors, or both.

Disclosures: The study did not receive any external funding. Dr. Sparks, Dr. Doyle, and Dr. Shadick reported receiving research support and consultancy fees from various sources.

Source: Martin LW et al. Semin Arthritis Rheum. 2021 Aug 20. doi: 10.1016/j.semarthrit.2021.08.005.

Key clinical point: The incidence of rheumatoid arthritis-related bronchiectasis (RA-BR) was almost 20%, suggesting that bronchiectasis is a common extra-articular feature of rheumatoid arthritis (RA).

Major finding: The pooled overall prevalence of RA-BR was 18.7% (95% CI 13.7%-24.3%) in the random effects meta-analysis and 22.6% (95% CI 16.8%-29.0%) in studies that used high-resolution chest computed tomography imaging.

Study details: Findings are from a systematic review and meta-analysis of 41 studies that reported on RA-BR prevalence, risk factors, or both.

Disclosures: The study did not receive any external funding. Dr. Sparks, Dr. Doyle, and Dr. Shadick reported receiving research support and consultancy fees from various sources.

Source: Martin LW et al. Semin Arthritis Rheum. 2021 Aug 20. doi: 10.1016/j.semarthrit.2021.08.005.

Key clinical point: The incidence of rheumatoid arthritis-related bronchiectasis (RA-BR) was almost 20%, suggesting that bronchiectasis is a common extra-articular feature of rheumatoid arthritis (RA).

Major finding: The pooled overall prevalence of RA-BR was 18.7% (95% CI 13.7%-24.3%) in the random effects meta-analysis and 22.6% (95% CI 16.8%-29.0%) in studies that used high-resolution chest computed tomography imaging.

Study details: Findings are from a systematic review and meta-analysis of 41 studies that reported on RA-BR prevalence, risk factors, or both.

Disclosures: The study did not receive any external funding. Dr. Sparks, Dr. Doyle, and Dr. Shadick reported receiving research support and consultancy fees from various sources.

Source: Martin LW et al. Semin Arthritis Rheum. 2021 Aug 20. doi: 10.1016/j.semarthrit.2021.08.005.

Key clinical point: Disease activity is associated with fatigue in early rheumatoid arthritis (RA), and patients who achieve early remission are at lower risk for experiencing fatigue.

Major finding: Patients who achieved remission at 6 months had a lower chance of experiencing fatigue at 24 months (Disease Activity Score 44 remission, odds ratio [OR] 0.31; P < .001). Fewer swollen joints (OR 0.92; P = .006), lower power Doppler ultrasound score (OR 0.95; P = .027), and a higher patient global assessment score (OR 1.03; P < .001) raised the likelihood of clinically relevant fatigue at 24 months.

Study details: The findings come from the analysis of 205 individuals from the ARCTIC trial. Patients were randomly assigned to a treat-to-target approach with and without musculoskeletal ultrasonography during clinical examinations and treatment decisions.

Disclosures: This work was supported by the DAM Foundation. Some of the authors declared receiving personal fees, personal honoraria, consultancy honorariums/fees, and serving on the data safety monitoring board or advisory board of various sources.

Source: Holton K et al. Ann Rheum Dis. 2021 Aug 13. doi: 10.1136/annrheumdis-2021-220750.

Key clinical point: Disease activity is associated with fatigue in early rheumatoid arthritis (RA), and patients who achieve early remission are at lower risk for experiencing fatigue.

Major finding: Patients who achieved remission at 6 months had a lower chance of experiencing fatigue at 24 months (Disease Activity Score 44 remission, odds ratio [OR] 0.31; P < .001). Fewer swollen joints (OR 0.92; P = .006), lower power Doppler ultrasound score (OR 0.95; P = .027), and a higher patient global assessment score (OR 1.03; P < .001) raised the likelihood of clinically relevant fatigue at 24 months.

Study details: The findings come from the analysis of 205 individuals from the ARCTIC trial. Patients were randomly assigned to a treat-to-target approach with and without musculoskeletal ultrasonography during clinical examinations and treatment decisions.

Disclosures: This work was supported by the DAM Foundation. Some of the authors declared receiving personal fees, personal honoraria, consultancy honorariums/fees, and serving on the data safety monitoring board or advisory board of various sources.

Source: Holton K et al. Ann Rheum Dis. 2021 Aug 13. doi: 10.1136/annrheumdis-2021-220750.

Key clinical point: Disease activity is associated with fatigue in early rheumatoid arthritis (RA), and patients who achieve early remission are at lower risk for experiencing fatigue.

Major finding: Patients who achieved remission at 6 months had a lower chance of experiencing fatigue at 24 months (Disease Activity Score 44 remission, odds ratio [OR] 0.31; P < .001). Fewer swollen joints (OR 0.92; P = .006), lower power Doppler ultrasound score (OR 0.95; P = .027), and a higher patient global assessment score (OR 1.03; P < .001) raised the likelihood of clinically relevant fatigue at 24 months.

Study details: The findings come from the analysis of 205 individuals from the ARCTIC trial. Patients were randomly assigned to a treat-to-target approach with and without musculoskeletal ultrasonography during clinical examinations and treatment decisions.

Disclosures: This work was supported by the DAM Foundation. Some of the authors declared receiving personal fees, personal honoraria, consultancy honorariums/fees, and serving on the data safety monitoring board or advisory board of various sources.

Source: Holton K et al. Ann Rheum Dis. 2021 Aug 13. doi: 10.1136/annrheumdis-2021-220750.

Key clinical point: Over 6 years of prospective follow-up found no association between recent antibiotic use and subsequent risk for rheumatoid arthritis (RA) later in life.

Major finding: Compared with no antibiotic usage, short-term (adjusted hazard ratio [aHR] 0.88; 95% CI 0.38-1.38) and middle-to-long-term (aHR 1.06; 95% CI 0.42-1.71) antibiotic use was not associated with an increased risk for RA.

Study details: The study included 1,33,125 female participants from Nurses' Health Study (NHS; n=58,757) and NHS II (n=74,368) databases. Based on antibiotic usage, participants were categorized into nonuse, short-term use (1-14 days), and middle-to-long-term use (15 or more days) groups.

Disclosures: This work was supported by the Natural Science Foundation of China, the Guangdong Provincial Key Laboratory of Digestive Cancer Research, the Startup Fund for the 100 Top Talents Program, the Sun Yat-sen University, and the National Institutes of Health. All the authors reported no conflict of interests.

Source: Liu Y et al. Expert Opin Drug Saf. 2021 Aug 25. doi: 10.1080/14740338.2021.1970134.

Key clinical point: Over 6 years of prospective follow-up found no association between recent antibiotic use and subsequent risk for rheumatoid arthritis (RA) later in life.

Major finding: Compared with no antibiotic usage, short-term (adjusted hazard ratio [aHR] 0.88; 95% CI 0.38-1.38) and middle-to-long-term (aHR 1.06; 95% CI 0.42-1.71) antibiotic use was not associated with an increased risk for RA.

Study details: The study included 1,33,125 female participants from Nurses' Health Study (NHS; n=58,757) and NHS II (n=74,368) databases. Based on antibiotic usage, participants were categorized into nonuse, short-term use (1-14 days), and middle-to-long-term use (15 or more days) groups.

Disclosures: This work was supported by the Natural Science Foundation of China, the Guangdong Provincial Key Laboratory of Digestive Cancer Research, the Startup Fund for the 100 Top Talents Program, the Sun Yat-sen University, and the National Institutes of Health. All the authors reported no conflict of interests.

Source: Liu Y et al. Expert Opin Drug Saf. 2021 Aug 25. doi: 10.1080/14740338.2021.1970134.

Key clinical point: Over 6 years of prospective follow-up found no association between recent antibiotic use and subsequent risk for rheumatoid arthritis (RA) later in life.

Major finding: Compared with no antibiotic usage, short-term (adjusted hazard ratio [aHR] 0.88; 95% CI 0.38-1.38) and middle-to-long-term (aHR 1.06; 95% CI 0.42-1.71) antibiotic use was not associated with an increased risk for RA.

Study details: The study included 1,33,125 female participants from Nurses' Health Study (NHS; n=58,757) and NHS II (n=74,368) databases. Based on antibiotic usage, participants were categorized into nonuse, short-term use (1-14 days), and middle-to-long-term use (15 or more days) groups.

Disclosures: This work was supported by the Natural Science Foundation of China, the Guangdong Provincial Key Laboratory of Digestive Cancer Research, the Startup Fund for the 100 Top Talents Program, the Sun Yat-sen University, and the National Institutes of Health. All the authors reported no conflict of interests.

Source: Liu Y et al. Expert Opin Drug Saf. 2021 Aug 25. doi: 10.1080/14740338.2021.1970134.

Key clinical point: Patients with rheumatoid arthritis (RA) had worse prognosis after coronary artery bypass grafting surgery (CABG) than matched controls.

Major finding: The risk for mortality at 14.3 years’ follow-up after CABG was significantly higher in patients diagnosed with RA than those without (hazard ratio [HR] 1.50; P < .0001). Moreover, patients with RA were at a higher risk for myocardial infarction during the follow-up period (HR 1.61; P < .0001).

Study details: This was a retrospective analysis of patients with RA (n=378) matched with those without RA (n=7,560), all treated with CABG.

Disclosures: The Finnish Cultural Foundation, the Paulon Säätiö Foundation, the Finnish Governmental VTR-funding, and Suomen Kulttuurirahasto funded this study. The authors disclosed receipt of travel grants, consulting/speaker fees, honoraria, and congress sponsorship from and serving on advisory boards for various sources.

Source: Malmberg M et al. Ann Med. 2021 Aug 31. doi: 10.1080/07853890.2021.1969591.

Key clinical point: Patients with rheumatoid arthritis (RA) had worse prognosis after coronary artery bypass grafting surgery (CABG) than matched controls.

Major finding: The risk for mortality at 14.3 years’ follow-up after CABG was significantly higher in patients diagnosed with RA than those without (hazard ratio [HR] 1.50; P < .0001). Moreover, patients with RA were at a higher risk for myocardial infarction during the follow-up period (HR 1.61; P < .0001).

Study details: This was a retrospective analysis of patients with RA (n=378) matched with those without RA (n=7,560), all treated with CABG.

Disclosures: The Finnish Cultural Foundation, the Paulon Säätiö Foundation, the Finnish Governmental VTR-funding, and Suomen Kulttuurirahasto funded this study. The authors disclosed receipt of travel grants, consulting/speaker fees, honoraria, and congress sponsorship from and serving on advisory boards for various sources.

Source: Malmberg M et al. Ann Med. 2021 Aug 31. doi: 10.1080/07853890.2021.1969591.

Key clinical point: Patients with rheumatoid arthritis (RA) had worse prognosis after coronary artery bypass grafting surgery (CABG) than matched controls.

Major finding: The risk for mortality at 14.3 years’ follow-up after CABG was significantly higher in patients diagnosed with RA than those without (hazard ratio [HR] 1.50; P < .0001). Moreover, patients with RA were at a higher risk for myocardial infarction during the follow-up period (HR 1.61; P < .0001).

Study details: This was a retrospective analysis of patients with RA (n=378) matched with those without RA (n=7,560), all treated with CABG.

Disclosures: The Finnish Cultural Foundation, the Paulon Säätiö Foundation, the Finnish Governmental VTR-funding, and Suomen Kulttuurirahasto funded this study. The authors disclosed receipt of travel grants, consulting/speaker fees, honoraria, and congress sponsorship from and serving on advisory boards for various sources.

Source: Malmberg M et al. Ann Med. 2021 Aug 31. doi: 10.1080/07853890.2021.1969591.

Key clinical point: Joint swelling associated with rheumatoid arthritis (RA) tends to recur in the same joints swollen at RA onset, even in patients who are intensively treated.

Major finding: Overall, 46% of joints swollen at baseline showed swelling recurrence at least once during follow-up. Baseline joint swelling was predictive for swelling during follow-up (odds ratio [OR] 2.37; P < .001) and recurrent, persistent swelling in joints swollen (OR 1.52) and not swollen (OR 1.73) at the previous visit (both P < .001).

Study details: This is a subanalysis of the BeSt (Behandel-Strategieën) study, a treat-to-target trial involving 508 patients with newly diagnosed active RA followed up for a median of 10 years.

Disclosures: The original BeSt study was funded by a research grant from the Dutch College of Health Insurances with additional funding from Schering-Plough BV and Centocor Inc.

Source: Heckert SL et al. Ann Rheum Dis. 2021 Aug 30. doi: 10.1136/annrheumdis-2021-220882.

Key clinical point: Joint swelling associated with rheumatoid arthritis (RA) tends to recur in the same joints swollen at RA onset, even in patients who are intensively treated.

Major finding: Overall, 46% of joints swollen at baseline showed swelling recurrence at least once during follow-up. Baseline joint swelling was predictive for swelling during follow-up (odds ratio [OR] 2.37; P < .001) and recurrent, persistent swelling in joints swollen (OR 1.52) and not swollen (OR 1.73) at the previous visit (both P < .001).

Study details: This is a subanalysis of the BeSt (Behandel-Strategieën) study, a treat-to-target trial involving 508 patients with newly diagnosed active RA followed up for a median of 10 years.

Disclosures: The original BeSt study was funded by a research grant from the Dutch College of Health Insurances with additional funding from Schering-Plough BV and Centocor Inc.

Source: Heckert SL et al. Ann Rheum Dis. 2021 Aug 30. doi: 10.1136/annrheumdis-2021-220882.

Key clinical point: Joint swelling associated with rheumatoid arthritis (RA) tends to recur in the same joints swollen at RA onset, even in patients who are intensively treated.

Major finding: Overall, 46% of joints swollen at baseline showed swelling recurrence at least once during follow-up. Baseline joint swelling was predictive for swelling during follow-up (odds ratio [OR] 2.37; P < .001) and recurrent, persistent swelling in joints swollen (OR 1.52) and not swollen (OR 1.73) at the previous visit (both P < .001).

Study details: This is a subanalysis of the BeSt (Behandel-Strategieën) study, a treat-to-target trial involving 508 patients with newly diagnosed active RA followed up for a median of 10 years.

Disclosures: The original BeSt study was funded by a research grant from the Dutch College of Health Insurances with additional funding from Schering-Plough BV and Centocor Inc.

Source: Heckert SL et al. Ann Rheum Dis. 2021 Aug 30. doi: 10.1136/annrheumdis-2021-220882.

Key clinical point: Passive smoking exposure in childhood is associated with adult-onset seropositive rheumatoid arthritis (RA), suggesting that early life exposures influence RA risk.

Major finding: After adjusting for confounders, maternal smoking during pregnancy was associated with all-incident RA (adjusted hazard ratio [aHR] 1.25; 95% CI 1.03-1.52) and seropositive RA (aHR 1.34; 95% CI 1.06-1.70), whereas childhood parental smoking was associated with seropositive RA (aHR 1.41; 95% CI 1.08-1.83).

Study details: This was an analysis of prospectively collected data from the Nurses’ Health Study II, involving 90,923 women.

Disclosures: This work was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases, Rheumatology Research Foundation, and National Institutes of Health. K Yoshida and J Sparks reported receiving research support and consultancy fees from various sources.

Source: Yoshida K et al. Arthritis Rheumatol. 2021 Aug 18. doi: 10.1002/art.41939.

Key clinical point: Passive smoking exposure in childhood is associated with adult-onset seropositive rheumatoid arthritis (RA), suggesting that early life exposures influence RA risk.

Major finding: After adjusting for confounders, maternal smoking during pregnancy was associated with all-incident RA (adjusted hazard ratio [aHR] 1.25; 95% CI 1.03-1.52) and seropositive RA (aHR 1.34; 95% CI 1.06-1.70), whereas childhood parental smoking was associated with seropositive RA (aHR 1.41; 95% CI 1.08-1.83).

Study details: This was an analysis of prospectively collected data from the Nurses’ Health Study II, involving 90,923 women.

Disclosures: This work was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases, Rheumatology Research Foundation, and National Institutes of Health. K Yoshida and J Sparks reported receiving research support and consultancy fees from various sources.

Source: Yoshida K et al. Arthritis Rheumatol. 2021 Aug 18. doi: 10.1002/art.41939.

Key clinical point: Passive smoking exposure in childhood is associated with adult-onset seropositive rheumatoid arthritis (RA), suggesting that early life exposures influence RA risk.

Major finding: After adjusting for confounders, maternal smoking during pregnancy was associated with all-incident RA (adjusted hazard ratio [aHR] 1.25; 95% CI 1.03-1.52) and seropositive RA (aHR 1.34; 95% CI 1.06-1.70), whereas childhood parental smoking was associated with seropositive RA (aHR 1.41; 95% CI 1.08-1.83).

Study details: This was an analysis of prospectively collected data from the Nurses’ Health Study II, involving 90,923 women.

Disclosures: This work was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases, Rheumatology Research Foundation, and National Institutes of Health. K Yoshida and J Sparks reported receiving research support and consultancy fees from various sources.

Source: Yoshida K et al. Arthritis Rheumatol. 2021 Aug 18. doi: 10.1002/art.41939.

Key clinical point: Combination therapy of methotrexate with tofacitinib or adalimumab improved outcomes in patients with rheumatoid arthritis (RA) who did not respond well to tofacitinib alone.

Major finding: Overall, greater response was achieved by 28.8%, 37.2%, and 39.1% of patients receiving tofacitinib monotherapy, tofacitinib + metotrexate, and adalimumab + methotrexate, respectively. Patients with greater response showed similar 12-month cumulative probability plots for a mean percentage change in Clinical Disease Activity Index across treatment. However, patients with lower responses receiving tofacitinib monotherapy did not respond as well as those receiving combination therapies.

Study details: The data come from a post hoc analysis of the ORAL Strategy trial, which included 1,146 patients with active RA despite methotrexate treatment who were randomly assigned to receive 5 mg tofacitinib twice daily, 5 mg tofacitinib twice daily + methotrexate, or 40 mg adalimumab every other week + methotrexate.

Disclosures: This study was funded by Pfizer Inc. Some of the authors reported receiving grants/research support and consultancy fees from various sources including Pfizer Inc. J Paulissen reported being an employee of Syneos Health. N Iikuni, H Shi, K Soma, and T Hirose reported being employees and shareholders of Pfizer Inc.

Source: Takeuchi T et al. Arthritis Res Ther. 2021 Aug 24. doi: 10.1186/s13075-021-02591-y.

Key clinical point: Combination therapy of methotrexate with tofacitinib or adalimumab improved outcomes in patients with rheumatoid arthritis (RA) who did not respond well to tofacitinib alone.

Major finding: Overall, greater response was achieved by 28.8%, 37.2%, and 39.1% of patients receiving tofacitinib monotherapy, tofacitinib + metotrexate, and adalimumab + methotrexate, respectively. Patients with greater response showed similar 12-month cumulative probability plots for a mean percentage change in Clinical Disease Activity Index across treatment. However, patients with lower responses receiving tofacitinib monotherapy did not respond as well as those receiving combination therapies.

Study details: The data come from a post hoc analysis of the ORAL Strategy trial, which included 1,146 patients with active RA despite methotrexate treatment who were randomly assigned to receive 5 mg tofacitinib twice daily, 5 mg tofacitinib twice daily + methotrexate, or 40 mg adalimumab every other week + methotrexate.

Disclosures: This study was funded by Pfizer Inc. Some of the authors reported receiving grants/research support and consultancy fees from various sources including Pfizer Inc. J Paulissen reported being an employee of Syneos Health. N Iikuni, H Shi, K Soma, and T Hirose reported being employees and shareholders of Pfizer Inc.

Source: Takeuchi T et al. Arthritis Res Ther. 2021 Aug 24. doi: 10.1186/s13075-021-02591-y.

Key clinical point: Combination therapy of methotrexate with tofacitinib or adalimumab improved outcomes in patients with rheumatoid arthritis (RA) who did not respond well to tofacitinib alone.

Major finding: Overall, greater response was achieved by 28.8%, 37.2%, and 39.1% of patients receiving tofacitinib monotherapy, tofacitinib + metotrexate, and adalimumab + methotrexate, respectively. Patients with greater response showed similar 12-month cumulative probability plots for a mean percentage change in Clinical Disease Activity Index across treatment. However, patients with lower responses receiving tofacitinib monotherapy did not respond as well as those receiving combination therapies.

Study details: The data come from a post hoc analysis of the ORAL Strategy trial, which included 1,146 patients with active RA despite methotrexate treatment who were randomly assigned to receive 5 mg tofacitinib twice daily, 5 mg tofacitinib twice daily + methotrexate, or 40 mg adalimumab every other week + methotrexate.

Disclosures: This study was funded by Pfizer Inc. Some of the authors reported receiving grants/research support and consultancy fees from various sources including Pfizer Inc. J Paulissen reported being an employee of Syneos Health. N Iikuni, H Shi, K Soma, and T Hirose reported being employees and shareholders of Pfizer Inc.

Source: Takeuchi T et al. Arthritis Res Ther. 2021 Aug 24. doi: 10.1186/s13075-021-02591-y.

Key clinical point: The combination of filgotinib 200 mg and methotrexate showed an incremental benefit vs. methotrexate monotherapy in methotrexate-naive patients with rheumatoid arthritis (RA) and poor prognostic factors (PPF) with no new safety signals.

Major finding: Among patients with 4 PPFs, methotrexate + 200 mg filgotinib vs. methotrexate monotherapy was associated with higher rates of American College of Rheumatology (ACR) core criteria 20 (85.5% vs. 74.7%), ACR50 (70.3% vs. 48.2%), and ACR70 (54.1% vs. 28.3%) responses at week 24 and weeks 12 and 52 (nominal P < .05 for all).

Study details: This was a post hoc analysis of the phase 3 FINCH 3 study involving 1,249 methotrexate-naive adult patients with moderate-to-severe active RA with multiple PPFs. Patients were randomly assigned to once-weekly methotrexate with once-daily oral filgotinib (200 mg or 100 mg), 200 mg filgotinib monotherapy, or oral methotrexate monotherapy for up to 52 weeks.

Disclosures: The study was funded by Gilead Sciences, Inc. The authors, including the lead author, reported receiving grants, speaker’s fees, and consultancy fees from various sources. Three authors reported being employees and shareholders of Gilead Sciences, Inc.

Source: Aletaha D et al. RMD Open. 2021 Aug 12. doi: 10.1136/rmdopen-2021-001621.

Key clinical point: The combination of filgotinib 200 mg and methotrexate showed an incremental benefit vs. methotrexate monotherapy in methotrexate-naive patients with rheumatoid arthritis (RA) and poor prognostic factors (PPF) with no new safety signals.

Major finding: Among patients with 4 PPFs, methotrexate + 200 mg filgotinib vs. methotrexate monotherapy was associated with higher rates of American College of Rheumatology (ACR) core criteria 20 (85.5% vs. 74.7%), ACR50 (70.3% vs. 48.2%), and ACR70 (54.1% vs. 28.3%) responses at week 24 and weeks 12 and 52 (nominal P < .05 for all).

Study details: This was a post hoc analysis of the phase 3 FINCH 3 study involving 1,249 methotrexate-naive adult patients with moderate-to-severe active RA with multiple PPFs. Patients were randomly assigned to once-weekly methotrexate with once-daily oral filgotinib (200 mg or 100 mg), 200 mg filgotinib monotherapy, or oral methotrexate monotherapy for up to 52 weeks.

Disclosures: The study was funded by Gilead Sciences, Inc. The authors, including the lead author, reported receiving grants, speaker’s fees, and consultancy fees from various sources. Three authors reported being employees and shareholders of Gilead Sciences, Inc.

Source: Aletaha D et al. RMD Open. 2021 Aug 12. doi: 10.1136/rmdopen-2021-001621.

Key clinical point: The combination of filgotinib 200 mg and methotrexate showed an incremental benefit vs. methotrexate monotherapy in methotrexate-naive patients with rheumatoid arthritis (RA) and poor prognostic factors (PPF) with no new safety signals.

Major finding: Among patients with 4 PPFs, methotrexate + 200 mg filgotinib vs. methotrexate monotherapy was associated with higher rates of American College of Rheumatology (ACR) core criteria 20 (85.5% vs. 74.7%), ACR50 (70.3% vs. 48.2%), and ACR70 (54.1% vs. 28.3%) responses at week 24 and weeks 12 and 52 (nominal P < .05 for all).

Study details: This was a post hoc analysis of the phase 3 FINCH 3 study involving 1,249 methotrexate-naive adult patients with moderate-to-severe active RA with multiple PPFs. Patients were randomly assigned to once-weekly methotrexate with once-daily oral filgotinib (200 mg or 100 mg), 200 mg filgotinib monotherapy, or oral methotrexate monotherapy for up to 52 weeks.

Disclosures: The study was funded by Gilead Sciences, Inc. The authors, including the lead author, reported receiving grants, speaker’s fees, and consultancy fees from various sources. Three authors reported being employees and shareholders of Gilead Sciences, Inc.

Source: Aletaha D et al. RMD Open. 2021 Aug 12. doi: 10.1136/rmdopen-2021-001621.