COMMENTARY

Rheumatology Advances to Know From 2015

Kevin Deane, MD, PhD

Disclosures

December 23, 2015

In This Article

New Therapies for Idiopathic Pulmonary Fibrosis

In late 2014, two agents were approved by the US Food and Drug Administration for the treatment of idiopathic pulmonary fibrosis: the tyrosine kinase inhibitor nintedanib[23] and the antifibrotic agent pirfenidone.[24,25] These drugs are offering hope for improved treatment of idiopathic pulmonary fibrosis, a disease in which multiple other agents have to date failed to show any meaningful benefit.[26]

The specific role for these two agents in rheumatic disease-associated lung disease has yet to be determined. However, because fibrosing lung disease often overlaps with rheumatic diseases, rheumatologists should be aware of these agents and watch for new data regarding how these agents may be used specifically in rheumatic disease.

New Therapy for Psoriatic Arthritis on the Horizon

The anti-interleukin 17A inhibitor secukinumab was approved in the United States in early 2015 for the treatment of moderate to severe plaque psoriasis. It is not yet approved for psoriatic arthritis; however, in trials of ~1000 patients, it has shown improvement in psoriatic skin and joint disease, as well as reduced radiographic progression of disease.[27,28] As such, it is a contender for approval for use in psoriatic arthritis in the near future.

Vasculitis Update

The past year saw increased evidence that rituximab is effective in antineutrophilic cytoplasmic antibody (ANCA)-associated vasculitis. In particular, Guillevin and colleagues[29] showed that rituximab was superior to azathioprine in maintaining disease remission. In addition, return of B cells after rituximab therapy was found in several studies to be a harbinger of disease flare.[30,31] Overall, in combination with the results from the Rituximab Versus Cyclophosphamide in ANCA-Positive Vasculitis (RAVE) trial,[32] these studies are all supporting a highly important role for rituximab in the management of all phases of ANCA-positive vasculitis.

2015 also saw an advance in the treatment of giant cell arteritis. Specifically, an open-label study of 22 patients showed that treatment with the anti-interleukin 6 agent tocilizumab dosed at 8 mg/kg monthly allowed tapering of steroids and prompted disease remission in 17 patients; however, 6 patients experienced significant adverse events, including multiple serious infections.[33] Larger controlled trials are under way that should hopefully soon provide more information on the efficacy and safety of this agent in giant cell arteritis.

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