Rare diseases

5 Australian research presentations from EULAR 2019

If you didn’t make it to this year’s EULAR 2019 Congress in Madrid, here are five of the top presentations from Australian groups.

The importance of flu vaccination for RA patients was highlighted by a Victorian study showing that their increased risk of hospitaliation for influenza was equivalent to that of people over 65. A review of more than 19,000 hospital admissions at Austin Health, Melbourne, found that patients with a history of RA were 65% more likely to have at least one primary admission for influenza (Odds Ratio 1.65) compared to people without RA. The level of risk was comparable to that experienced by patients older than 65 years old (OR 1.62 ) and stronger than that experienced by smokers (OR 1.38). “Funding authorities should consider making influenza vaccination available for RA patients in a comparable way to that available to patients aged over 65 years old,” the researchers recommended.

Significant improvements in nail psoriasis were seen in Australian patients with psoriatic arthritis treated with secukinumab for a year as part of  an international study. Led by study investigator Professor Peter Nash of the University of Queensland, the FUTURE 5 study saw 996 patients with active PsA randomised to monthly injections of subcutaneous secukinumab or placebo. Two thirds of patients (66.6%) had concomitant nail nail psoriasis at baseline which showed improvement with the 300 and 150 mg doses of secukinumab when compared to placebo over the first 16 weeks, and with further improvements through Week 52. Improvements were also seen in measures such as ACR20/50 and PASI 90 responses, resolution of dactylitis and enthesitis, physical function and QoL with secukinumab compared to placebo.

In patients with SLE, the Lupus Low Disease Activity State (LLDAS) definition may be useful as a treat-to-target endpoint since attainment is associated with protections against permanent damage accrual, according to Monash University research. In a prospective multinational cohort study, 1,735 SLE patients were followed for an average of 2.2 years to assess the influence of LLDAS on damage accrual in patients who had active disease at baseline (SLEDAI-2K ≥ 6). LLDAS attainment was less frequent in the 23.5% of patients with active disease at baseline compared to patients with less active disease. However, risk of damage accrual was reduced by more than half (Hazard Ratio 0.49) in patients with active disease if they achieved LLDAS compared to a reduction in risk of 28% (HR 0.72) in those with less active disease.  “This supports the validity of LLDAS as an outcome measure … and further highlights the potential impact of achieving a target outcome in SLE patients with active disease,” the study investigators concluded.

There is considerable scope to reduce repeat anti-nuclear antibody (ANA) testing because it is a poor predictor of rheumatological conditions after an initial negative results, Victorian researchers say. In a seven year retrospective analysis of 36,715 ANA tests in a tertiary health network in Melbourne, they found that testing cost more than $903,000, of which repeat testing accounted for about 20% ($194,000). Only 6.5% of the repeat test results changed from negative to positive, with a median time between a negative ANA result to the first positive result of 1.71 years. When comparing patients who with a new diagnosis to those with no new diagnosis, there was no difference between ANA titre, pattern, duration to first positive ANA, ordering location or clinician, or age of first positive ANA test. “Repeat ANA testing after a negative result had limited utility in the diagnosis of ANA-associated rheumatological conditions with a positive predictive value of only 0.01,” the study investigators noted. “New technology and clinical alert systems may help reduce unnecessary testing with potential significant direct cost savings when extrapolated across the Australian healthcare system.

The Australian OPAL dataset shows that in RA patients tofacitinib has treatment effectiveness and persistence similar to bDMARDs. The analysis included data from 650 patients starting tofacitinib and 1300 bDMARD initiators. Rates of DAS remission were  49.7% vs 49.1% at three months  and 57.8% vs 52.4% of patients at 18 months for tofacitinib vs bDMARDs. Median persistence of treatment was similar for bDMARD and tofacitinib groups: 33.8 and 34.2 months respectively. In the overall population, more patients were prescribed tofacitinib as monotherapy (43.4%) compared to bDMARD monotherapy (33.4%).

More Australian women with rheumatological diseases are staying on TNFi therapy during pregnancy and the postpartum period, in keeping with recently updated guideline recommendations on their safety, according to a University of Queensland study. Data from the Pregnancy Exposed to Biological (PEB) study involving 37 infants born to 29 mothers showed that 67% (16/24) of the women stopped their TNFi pre-conception in the era before 2016 when new guidelines on the safety of TNFi in pregnancy were published by the British Society of Rheumatology. Following guideline publication, only 25% (n=2/8) of women ceased TNFi pre-conception. Rates of breastfeeding among women taking TNFi increased from 79% to 100% after the TNFi safety guidelines were published. The study investigators noted that vaccination recommendations – particularly in relation to delay of live vaccines – were not being followed by some women taking TNFi.

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