News in brief: JAK inhibitor indication extended; Elderly with GCA still benefit from IL-6 inhibitor; Low value from imaging low back pain

Thursday, 27 May 2021

JAK1 inhibitor indication extended

Upadacitinib (Rinvoq) has been registered in Australia for the treatment of moderate to severe active psoriatic arthritis (PsA) and active ankylosing spondylitis (AS).

The selective JAK1 inhibitor was currently only available in Australia – and PBS listed – for severe active rheumatoid arthritis.

Upadacitinib, according to the Product Information, may be used as monotherapy or in combination with a non-biological DMARD.

The recommended dose of the once-daily treatment is 15mg.

Elderly with GCA still benefit from IL-6 inhibitor

Tocilizumab remains a valuable glucocorticoid-sparing option in elderly patients over 80 years with giant cell arteritis (GCA).

A small French study of 21 patients with a mean age of 84 years found two-thirds of patients were able to stop glucocorticoid use after a median delay of 8 months.

The study also found a third of patients receiving tocilizumab experienced mild-to-moderate adverse events, commonly hypercholesterolemia. Serious adverse events with ≥ grade 3 toxicities were observed in four (19%) patients.

“Although GC remains the cornerstone of the treatment and is sufficient for most patients, some circumstances can require an adjunctive immunosuppressant to achieve disease remission or to decrease GC use more quickly,” the study said.

Arthritis Research & Therapy

Black and white: low value from imaging low back pain

There is more evidence against routine diagnostic imaging in middle-aged, community dwelling women with low back pain.

A prospective cohort study of up to 650 women found no association between a higher number of radiographic changes such as K-L grade, osteophytes and disc space narrowing, and severe back pain-related disability.

The UK study confirmed the low value of imaging in this indication.

“Overall, the prevalence of lumbar spine radiographic findings in our study is similar to that of previous studies that indicated that many imaging-based spinal radiographic changes are likely part of normal, asymptomatic ageing.”

“Clinicians may use the results of this study to educate patients and their colleagues that lumbar radiographic findings cannot provide prognostic information on back pain–related disability, further adding to the evidence supporting the urge to reduce unnecessary imaging referrals.”

JAMA Network Open

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