Damian McNamara

October 30, 2017

SAN DIEGEO — A highly anticipated clinical trial looking at whether response to the flu vaccine can be improved in people with rheumatoid arthritis by temporarily stopping methotrexate for 2 weeks before immunization will be presented at the upcoming at American College of Rheumatology (ACR) 2017 Annual Meeting.

"That is a really interesting clinical trial," said Richard Loeser Jr, MD, from the Thurston Arthritis Research Center at the University of North Carolina in Chapel Hill, who is chair of the scientific program committee for the meeting.

"There is always a concern in our patients, because they have immune disorders, about how well they are going to respond to the flu vaccine," he told Medscape Medical News.

The findings will be presented during the Sunday plenary session, "where we normally put the most important, highest-ranking trials," said Dr Loeser. "The plenary sessions are not all trials, but that is where the important trials end up."

Among the late-breaking abstracts presented will be a clinical trial assessing a new injectable therapy for people with osteoarthritis that might have some effect on cartilage. There will also be studies on psoriatic arthritis, ankylosing spondylitis, and lupus that will generate interest among rheumatologists, he predicted.

Pain, Cancer, and Precision Medicine

Pain is one of three themes at this year's conference. "Pain is a topic where there is a lot of interest because of the opioid epidemic," said Dr Loeser, particularly because rheumatologists treat a lot of people with chronic pain.

The meeting will have presentations on the genetics of pain, advances in imaging, and treatment strategies. And the session on pediatrics is important in terms of how you best treat children and avoid things like opioids, he added.

There will also be several presentations on the relation between cancer and autoimmunity. For example, checkpoint inhibitors, a new cancer-fighting therapy, act by stimulating the immune system, "which is good for fighting cancer but it can also increase autoimmune diseases," Dr Loeser explained.

Advances in precision care will be addressed during premeeting courses, and a state-of-the-art update will be delivered by Maria Virginia Pascual, MD, director of the Gale and Ira Drukier Institute for Children's Health in New York City.

There will also be a talk on phenotyping for hip and knee osteoarthritis. "I think that will be of interest to people," said Dr Loeser. "It's really important to target the right therapy to the right person. That's becoming very clear in rheumatology."

Biosimilar Switching: The Great Debate

The Great Debate this year will focus on biosimilars. "There is a lot of interest among rheumatologists who want to know whether these are as good as the original biologics, and whether or not you should switch a patient who has been doing well on a biologic to a biosimilar," said Dr Loeser. There is also a concern that insurance companies might start requiring patients switch to a less-expensive agent.

"A lot of these biologics are antibodies or recombinant proteins, and it's hard to make them exactly like the original," he explained.

The Paul Klemperer Memorial Lecture will be given by Ravinder Maini, MB BChir, who was part of the team that pioneered the use of tumor necrosis factor (TNF) inhibitors to treat arthritis.

"He was actually knighted for that, so it's Sir Ravinder Maini," said Dr Loeser. The lecture will address how TNF inhibitors were discovered, how they evolved, and how they are currently used. "I'm really looking forward to hearing that one," he said.

The Opening Session — an update on emerging and re-emerging infectious diseases, from AIDS to Zika — will be delivered by Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases. That session will be followed by a social and networking reception at the Hilton Hotel.

"No matter what area of rheumatology — whether it's lupus, rheumatoid arthritis, or osteoarthritis — we've got everything covered this year," Dr Loeser said.

"When we poll attendees about why they come to the annual meeting, the number 1 response is always networking and meeting with colleagues," he added. "There is a lot of opportunity for that. We are expecting close to 17,000 attendees."

Dr Loeser has disclosed no relevant financial relationships.

Follow Medscape Gastroenterology on Twitter @MedscapeGastro and Damian McNamara @MedReporter

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