COMMENTARY

From Paris, New Data on Treating Rheumatoid Arthritis

Michael H. Schiff, MD

Disclosures

July 03, 2014

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I am Dr. Michael Schiff, reporting from the 2014 European League Against Rheumatism (EULAR) Annual Congress of Rheumatology, here in Paris, France. Thank you for joining me today. At many of the congresses, both the American College of Rheumatology and EULAR, lots of new and interesting information is made available to help clinicians take care of our patients in a better way.

A big topic with multiple abstracts at this congress addressed the issue of monotherapy with or without methotrexate with tocilizumab or abatacept. Multiple abstracts have been presented, with data showing not only that tocilizumab monotherapy is effective, but if combined with methotrexate, we can get a better response and a better long-term response. For example, the databases from Europe have shown that the retention rate can be 2.2 years on monotherapy and 3.5 years if tocilizumab is combined with methotrexate.[1] Similar information has been presented looking at abatacept with or without methotrexate.[2]

The AVERT study[3] was a 3-arm study. One arm was abatacept plus methotrexate, the second was abatacept monotherapy, and the third was methotrexate monotherapy. Methotrexate plus abatacept achieved much better remission outcomes and a higher percentage of remission than either the methotrexate or the abatacept monotherapy. A Japanese study[4] confirmed this finding, although there are datasets, including the ORA database[5] from France, presented at this meeting, which showed that monotherapy can be very effective with abatacept if the patient cannot take methotrexate.

This meeting also addressed one of our old friends, the anchor therapy for rheumatoid arthritis that we all prescribe if there is no contraindication, and that is methotrexate. A group from England, headed by Tony Hammond,[6] showed that if oral methotrexate results in an incomplete response, then switching to parenteral or subcutaneous methotrexate can provide very good responses. A very interesting abstract from a Swiss group in St. Gallen, from Rodrigo Mueller and Johansen von Kempis,[7] showed that if we start with methotrexate subcutaneously, 51% of our patients will have low disease activity or remission and not have to add a biologic agent or put off needing a biologic agent for at least 1 year.

Methotrexate is being tweaked and being looked at again. A lot of new information was presented at the EULAR Congress, as well as new therapies for rheumatoid arthritis. Among these new therapies are the Janus kinase (JAK) inhibitors. We have seen VX-509, a Vertex product that looks very good in the phase 2 data.[8] We also have seen data from Galapagos and their JAK inhibitor,[9] and we have seen other JAK inhibitor data that all look very good. This is something to keep our eyes on for the future, if and when these agents are available for clinical rheumatologists to prescribe for our patients.

Thank you for listening to this report from the EULAR Congress in Paris, France. It has been a very exciting meeting with a lot of information to help clinicians and patients with rheumatoid arthritis.

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