Clinical highlights of 2017

This year’s popular “Year in Review” clinical session was unveiled by Dr Daniel H. Solomon, MD, of Brigham and Women’s Hospital and Harvard Medical School in Boston.

He told delegates that, with a little help from his friends, he had reviewed the Rheumatology, Internal Medicine and Paediatric journals to come up with a list of 19 studies published over the past 12 months that he considers to be the most important and influential.

Clinical highlights 2017

Fine-mapping the MHC locus in juvenile idiopathic arthritis (JIA) reveals genetic heterogeneity corresponding to distinct adult inflammatory arthritic diseases, Hinks, A. Bowes, J et al. Annals of the Rheumatic Diseases (link)

Key message: Future JIA classification criteria may be based on genotype and not only clinical presentation.

Trial of tocilizumab in Giant-Cell arteritis, Stone, J Tuckwell, K. et al. N Engl J Med 2017; 377: 317-328. (Link)

Key message: TOC offers an alternative treatment for GCA that should limit prednisone dosage while improving clinical outcomes.

Mepolizumab or placebo for eosinophilic granulomatosis with polyangiiitis Wechsler, M. Akuthota, A. et al. N Engl J Med 2017; 376:1921-1932. (link)

Key message: MEP offers an alternative treatment for EGPA that should limit steroid dosage while improving clinical outcomes.

Antiinflammatory therapy with canakinumab for atherosclerotic disease Ridker, O. Everett, B. et al. N Engl J Med 2017 377:1119-1131. (link)

Key message: Immunosuppression with an IL-1 antagonist reduces CV events, with success based on inflammation reduction.

Cardiovascular safety of celecoxib, naproxen, or ibuprofen for arthritis (PRECISION). Nissen, S. Yeomans, N. et al. N  Engl J Med 2016; 2519-2529. (link)

Key message: The PRECISION trial provides statistically strong evidence that the cardiovascular risk associated with moderate doses of celecoxib is not greater than that associated with nonselective NSAIDs.

Differential blood pressure effects of ibuprofen, naproxen and celecoxib in patients with arthritis: the PRECISION- ABPM (prospective randomized evaluation of celecoxib integrated safety versus ibuprofen or naproxen ambulatory blood pressure measurement) trial. Ruschitzka, F. Borer, J. et al. Eur Heart J 2017; doi: 10.1093/eurheartj/ehx508. [Epub ahead of print]. (link)

Key message: Allocation to the non-selective NSAID ibuprofen, compared with the COX-2 selective inhibitor celecoxib was associated with a significant increase of SBP, and a higher incidence of new-onset hypertension.

Effect of intra-articular triamcinolone vs saline on knee cartilage volume and pain in patients with knee osteoarthritis: A randomized clinical trial. McAlindon, T. LaValley, M. et al;. JAMA 2017; 317: 1967-1075. (link)

Key message: IA steroids work as well as saline for KOA with synovitis; both are associated with reduced pain and improved function. However, IA steroids may cause cartilage damage.

Anifrolumab, an anti-interferon -ɑ receptor monoclonal antibody, in moderate to severe systemic lupus erythematosus. Furie, R. Khamashta. Arthritis & Rheumatol 2017; 69(2): 376–386 (link.)

Key Message: ANIF appears to hold promise for reducing SLE disease activity in the subgroup with a high IFN gene signature.

Baricitinib versus placebo or adalimumab in rheumatoid arthritis. Taylor, P. Keystone, E. et al. N Engl J Med 2017; 376: 652-662. (link)

Key message: BARI demonstrates efficacy for RA and compares favorably with ADA, however DVT/PE concerns have prevented FDA approval.

Tofacitinib for psoriatic arthritis in patients with an inadequate response to TNF inhibitors. Gladman, D. Rigby, W. et al. N Engl J Med 2017; 377:1525-1536. (link)

Key message: TOFA demonstrates efficacy, similar to ADA, in PsA.

Incidence and prognosis of psoriasis and psoriatic arthritis in patients undergoing bariatric surgery. Egeberg, A. Sørensen, J. JAMA Surg 2017; 152 (4) 344-349.  (link)

Key message: Gastric bypass associates with a reduced risk of PsO and PsA, possibly providing insights into metabolic correlates associated with PsO/PsA.

Tofacitinib in patients with ankylosing spondylitis: a phase II, 16 week, randomised placebo controlled, dose ranging study. Van der Heijde, Deodhar, A. et al. Annals of the Rheumatic Diseases 2017; (link)

Key message: TOFA demonstrates short-term efficacy for AS with evidence of radiographic improvement. Adverse event profile was typical of TOFA (shingles).

Effect of secukinumab on patient reported outcomes in patients with active ankylosing spondylitis: A Phase III randomized trial (MEASURE 1). Deodhar, A. Dougados, M. et al. Arthritis & Rheumatology 2017; 68: 2901-2910. (link)

Key Message: SEC provides significant benefits on PROs for AS.

Effects of the dietary approaches to stop hypertension (DASH) diet and sodium intake on serum uric acid. Juraschek, S. Gelber, A. et al. Arthritis & Rheumatology 2017; online doi: 10.1002/art.39813. (link).

Key message: In specific subgroups, diet effectively lowers SUA.

Lesinurad combined with allopurinol: A randomized double-blind placebo controlled study in gout patients with an inadequate response to standard-of-care allopurinol (a US based study. Saag, K. Fitz-Patrick, D. Arthritis & Rheumatology 2016; doi: 10.1002/art.39840. (link)

Key message: Lesinurad, in combination with ALLO, lowers SUA. 400mg produced better reductions in SUA than 200mg but with increased adverse events.

Early mortality in a multinational systemic sclerosis inception cohort. Hao, Y. Hudson, M. et al. Arthritis & Rheumatology 2017; doi: 10.1002/art.40027. (link)

Key message: Mortality associated with systemic sclerosis is 4-fold higher than expected; cardiac, lung, gut, renal are causes.

Romosozumab or alendronate for fracture prevention in women with osteoporosis Saag, K.  Petersen, J. N Engl J Med 2017;377:1417-27. (link).

Key message: ROMO improves BMD and reduces the risk of all fracture types, but CV risk concerns have prevented FDA approval.

Malignant neoplasms in patients with rheumatoid arthritis treated with tumor necrosis factor inhibitors tocilizumab, abatacept, or rituximab in clinical practice: A nationwide cohort study from Sweden. Wardstrom H, Frisell, T. et al.  JAMA Intern Med 2017;  doi: 10.1001/jamainternmed.2017.4332. (link).

Key message: These results should increase confidence that TNFi’s are not associated with malignancy; as well, there are no clear cancer risks associated with other bDMARDs.

Risk of serious infections associated with use of immunosuppressive agents in pregnant women with autoimmune inflammatory conditions: cohort study. Desai, R. Bateman B. et al. BMJ 2017;356:j895. (link)

Key message: The risk of infection during pregnancy does not appear to be increased when comparing nbDMARDs or TNFi’s to steroids, but steroids correlate with increased risk.

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