Systemic Sclerosis, OA, and Gout Updates
Several novel therapeutic concepts are currently being developed for SSc, and pilot studies have demonstrated promising results. However, disease manifestations, such as arthritis, contractures, severe gastrointestinal involvement, and calcinosis, remain challenging to address. The EULAR Scleroderma Trial and Research network is an initiative of great importance for collaborative attempts toward understanding the pathogenesis and etiology of the disease, as well as the development of new treatments.
Dr Otylia Kowal-Bielecka from the Medical University of Bialystok, Poland, presented the updated EULAR recommendations for the treatment of SSc.[30] Compared with the 2009 EULAR recommendations, the 2015 recommendations include phosphodiesterase-5 inhibitors for the treatment of SSc-related Raynaud phenomenon and digital ulcers. For SSc-related pulmonary arterial hypertension, there are new recommendations for riociguat, endothelin receptor antagonists, prostacyclin analogues, and phosphodiesterase-5 inhibitors. Other new recommendations include fluoxetine for the treatment of SSc-related Raynaud phenomenon and hematopoietic stem cell transplantation for rapidly progressing SSc.
In addition to these new recommendations, new data on treatment options were also presented. Denton and colleagues[31] reported results from two multicenter, randomized, double-blind, placebo-controlled trials (DUAL-1 and DUAL-2) designed to assess the potential benefit of macitentan, an endothelin receptor antagonist, on digital ulcers in patients with SSc.[31] Neither in DUAL-1 nor in DUAL-2 did treatment with macitentan reduce the cumulative number of new digital ulcers over 16 weeks.
Osteoporosis and Gout: New Treatment Developments
New data were presented on romosozumab, a sclerostin antibody, for the treatment of osteoporosis. McClung and colleagues[32] reported on the effects of 2 years of treatment with romosozumab followed by 1 year of denosumab or placebo in postmenopausal women with low bone mineral density. Romosozumab led to rapid and marked increases in lumbar spine and total hip bone mineral density over 2 years, which continued during treatment with denosumab but not during treatment with placebo.
For gout, new data were presented on lesinurad, a selective uric acid reabsorption inhibitor. Tausche and colleagues[33] presented results from a multicenter, randomized, double-blind, placebo-controlled, phase 3 clinical trial of lesinurad in patients with gout who were intolerant to xanthine oxidase inhibitors. Significantly more lesinurad-treated patients achieved serum uric acid levels below 6 mg/dL after 6 months of treatment compared with placebo-treated patients. However, the rates of adverse events and discontinuation was higher in the lesinurad group.
Until Next Year in London!
This concludes my personal list of highlights from this year's EULAR meeting in Rome. Abstracts from this meeting and prior EULAR meetings can be found in the abstract archive on the EULAR website.[34] I hope to see you at next year's meeting in London.
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Cite this: Ioannis Parodis. From Rome, the Latest in Rheumatology - Medscape - Aug 10, 2015.
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