Sunday, May 28, 2023
Among this year's highlights:
- Tocilizumab improves rheumatoid arthritis symptoms rapidly;
- TNF inhibitors are associated with decreased risk for Alzheimer's disease in rheumatoid arthritis
- The incidence of gout is increasing; rilonacept decreases gouty flares
- Fructose intake is associated with an increased risk for gout
- Lupus is linked to increased risk for cancer
- Topical diclofenac has equal efficacy and fewer adverse effects than the oral version
Philip Seo, MD, MHS, codirector of the Johns Hopkins Vaculitis Center and an assistant professor in the Division of Rheumatology, Johns Hopkins University School of Medicine, in Baltimore, Maryland, speaks about his research on conversion immunosuppressive agents in the treatment of Wegener's granulomatosis and microscopic polyangiitis.
Diclofenac sodium topical solution 1.5% w/w (Pennsaid; Coviden) appears to be as effective as oral diclofenac in the management of osteoarthritis of the knee but has significantly fewer gastrointestinal and cardiovascular adverse effects, reported Sanford H. Roth, MD, from Arizona State University in Phoenix. Full news coverage: Topical vs Oral Diclofenac: Equal Efficacy, Fewer Adverse Effects
The BLISS-76 results, presented by Michelle Petri, MD, from the Johns Hopkins University School of Medicine, in Baltimore, Maryland, showed that belimumab, a B lymphocyte stimulator–specific inhibitor, significantly reduced systemic lupus erythematosus (SLE) disease activity at 76 weeks in SLE-seropositive patients, allowing for significant reductions in corticosteroids. Of 376 patients with SLE receiving belimumab and prednisone doses higher than 7.5 mg/day at baseline, approximately one quarter were able to reduce their steroid dose by more than 25% compared with those on prednisone alone. Among patients receiving prednisone doses higher than 7.5 mg/day at baseline, mean steroid reduction was 4.0 mg/day with belimumab 1 mg/kg, 4.6 mg/day with belimumab 10 mg/kg, and 3.5 mg/day with placebo at week 52. Full news coverage: Belimumab Reduces Disease Activity and Corticosteroid Use in SLE
Consuming sugar-sweetened sodas, orange juice, and fructose is associated with an increased risk for incident gout, according to new research findings from the Nurses' Health Study, presented by Hyon K. Choi, MD, DrPH, from the Boston University School of Medicine, in Massachusetts. Of 78,906 nurses in the study without gout at baseline, 778 incident cases of gout were reported between 1984 and 2006. Compared with the consumption of less than 1 serving per month of sugar-sweetened soda, the consumption of 1 serving per day was associated with a 1.74-fold increased risk for gout, and the consumption of 2 or more servings per day was associated with a 2.39-fold increased risk. Full news coverage: Fructose Intake Associated With an Increased Risk for Gout
Pegloticase appears to reduce joint swelling and tenderness in patients with chronic gout who are refractory to conventional urate-lowering therapy, according the results from replicate double-blinded, placebo-controlled, phase 3 trials, presented by David R. Mandel, MD, a clinician in private practice in Mayfield Village, Ohio. Full news coverage: Pegloticase Benefits Patients With Treatment-Refractory Gout
Patients with systemic lupus erythematosus (SLE) are 15% times more likely to develop cancer compared with the general population, suggest findings of a study involving nearly 13,500 people with SLE. There is a 3-fold increased risk for all lymphomas, a more than 3-fold increased risk for non-Hodgkin lymphoma, a nearly 3-fold risk for vulvo-vaginal cancers, and double the risk for liver cancer, said Sasha R. Bernatsky, MD, from McGill University in Montreal, Canada. Full news coverage: Lupus Linked to Increased Risk of Cancer
Tocilizumab appears to improve rheumatoid arthritis symptoms within 28 days, according to results from a phase 3b study, announced by Eugen Feist, MD, from Campus Charité Mitte, in Berlin, Germany. Of the 286 patients, 57% reached a low disease activity state, defined as a Disease Activity Score (DAS28) score of 3.2 or less at week 24. A state of DAS remission, defined as a DAS28 score below 2.6, was achieved by 48% of the patients at week 24. Full news coverage: Tocilizumab Improves RA Symptoms Rapidly
HZT-501 (Horizon Pharma, Inc), a single-tablet formulation containing 800 mg ibuprofen and 26.6 mg histamine2-receptor antagonist famotidine, reduced the incidence of upper gastrointestinal ulcers, relative to ibuprofen alone, for both the entire study population (14.0% vs 34.5%; P = .004) and the subgroup receiving low-dose aspirin (14.1% vs 26.5%; P < .0001), according to findings from a phase 3 study presented by Michael Weinblatt, MD, from Brigham and Women's Hospital in Boston, Massachusetts. In addition, the discontinuation rate was significantly lower in the HZT-501 group than in the ibuprofen group (31.0% vs 42.9%; P < .0001), primarily because of a reduced incidence of dyspepsia. Full news coverage: Ibuprofen/Famotidine Reduces Gastric Ulcer Incidence
Modified-release prednisone is more effective for morning symptoms of chronic rheumatoid arthritis than immediate-release prednisone or placebo, according to results from the Circadian Administration of Prednisone in Rheumatoid Arthritis (CAPRA) trials, reported by Frank Buttgereit, MD, from Charité University in Berlin, Germany. Low-dose modified-release prednisone tablets are designed to deliver the drug during nighttime hours to prevent the increase in inflammatory cytokines, thereby improving morning symptoms. "The hypothesis is that these increased levels of cytokines are driving immunological processes on the cellular and organ level, and are then being translated into the clinical morning symptoms," Dr. Buttgereit told Medscape Medical News. Full news coverage: Modified-Release Prednisone Safe and Effective in Rheumatoid Arthritis
Results of the long-term (112 weeks) open-label extension phase of the FAST4WARD trial, in which 220 patients with rheumatoid arthritis who had failed at least 1 disease-modifying antirheumatic drug were randomly assigned to receive either monotherapy with certolizumab pegol (Cimzia, UCB) 400 mg or placebo, were reported here at ACR 2010. "Certolizumab pegol monotherapy — without methotrexate or other disease-modifying antirheumatic drugs (DMARDs) — has now been demonstrated to be effective clinically for at least 2 years and to increase normal function for the patient," the FAST4WARD researchers reported. Coinvestigator Ronald van Vollenhoven, MD, PhD, from Karolinska University, in Stockholm, Sweden, discussed the FAST4WARD result with meeting attendees. Full news coverage: Certolizumab Pegol Safe and Effective Over Long Term in RA
Denosumab (Prolia; Amgen), a fully human monoclonal antibody that targets RANKL (receptor activator for nuclear factor κB ligand), and a key mediator of osteoclast activity, reduces the risk for vertebral and nonvertebral fracture risk and improved bone mineral density, regardless of the level of renal function. In addition, it has proved to be safe for at least 3 years in older patients with renal impairment, according to results from a phase 3 study. Ogo Egbuna, MD, discussed the results with meeting attendees during a poster session. Denosumab is currently approved for use in postmenopausal women at risk for osteoporosis. Full news coverage: Denosumab Safe, Effective for Osteoporosis and Renal Impairment
Rilonacept (IL-1 Trap; Takeda Pharmaceuticals, Inc), a fusion protein that binds and neutralizes interleukin 1, reduces the incidence of multiple gouty flares by 84% for patients treated with 80 mg rilonacept and allopurinol and by 88% for those treated with 160 mg rilonacept and allopurinol compared with patients receiving allopurinol alone (P < .0001). "The [findings] suggest that rilonacept is new way of preventing gouty flares in people starting urate-lowering therapy, and I think that's a major advance," Robert Terkeltaub, MD, from the Veterans Affairs Medical Center, in San Diego, California, told Medscape Medical News. Rilonacept did not reduce pain associated with flares. Full news coverage: Rilonacept Prophylactic Against Gout Flares
A 12-week, placebo-controlled study of epratuzumab (UCB) showed that patients with moderate to severe SLE receiving active treatment had a 45.9% responder rate with high-dose treatment, whereas patients receiving placebo had a response rate of 21.1%. Epratuzumab is an experimental humanized anti-CD22 monoclonal antibody in development for the treatment of inflammatory autoimmune disorders, including SLE. "This was a dose-finding study that clearly demonstrates the efficacy of this agent," Daniel J. Wallace, MD, a rheumatologist in private practice in Los Angeles, California, told Medscape Medical News. Full news coverage: Epratuzumab Effective in Systemic Lupus Erythematosus
On November 10, 2010, the ACR partnered with 9 national patient organizations to hold the "I Need My Rheumatologist" Call-in Day. The objective was to fight cuts to Medicare, which the organizers say will cause access-to-care problems for rheumatology patients and financial turmoil for rheumatology practices. "By failing to repeal the sustainable growth rate, Congress is demonstrating that healthcare for people on Medicare — primarily senior citizens, people on disability, and military families — is not a priority, and this is simply unacceptable to the rheumatology community," said ACR President Stanley B. Cohen, MD, a practicing rheumatologist in Dallas, Texas.
Results from an integrated analysis of more than 12,000 patient-years of safety data, performed by Marc C. Hochberg, MD, MPH, from the University of Maryland, in Baltimore, and colleagues, demonstrate that abatacept is generally well-tolerated in patients with rheumatoid arthritis. Exposure to the drug during a 7-year period was not associated with an increased incidence of serious adverse events. The most common adverse events were infections requiring hospitalization, which occurred at an incidence of 2.64 per 100 patient-years, and most common serious infections included pneumonia (0.46/100 patient-years), urinary tract infection (0.2/100 patient-years), and cellulitis (0.18/100 patient-years). Full news coverage: Abatacept Demonstrates Long-Term Safety in Rheumatoid Arthritis
Photographs by Neil Dent, Freelance Photographer, Atlanta, Georgia
Martha Kerr, Conference News Editor, Medscape Medical News, East Haddam, Connecticut
Martha Kerr has disclosed no relevant financial relationships.
Jane Hwang, Senior Editor/Photo, Medscape, New York City
Jane Hwang has disclosed no relevant financial relationships.
Emma Hitt, PhD, Freelance Journalist, Atlanta, Georgia
Emma Hitt has disclosed no relevant financial relationships.
For more information, see the following resources:
Top News Stories From the ASCO® 2010 Annual Meeting
Top News Stories From the APA 2010 Annual Meeting
American Academy of Neurology (AAN) 62nd Annual Meeting: Top Research Highlights
American Academy of Pain Medicine (AAPM) 2010: Top Research Slideshow
