News in brief: Self-management program for AS; Will COVID-19 vaccine work in rheumatology patients?; TNFi after first biologic failure

Self-management success in AS

A novel self-management program for people with ankylosing spondylitis can produce significant and sustained benefits in symptoms, disease activity measures and quality of life, a pilot program run out of the Sir Charles Gairdner Hospital, in WA has found.

Adopted from self-management programs used in RA and OA, the six week small-group sessions  included an education competent explaining AS, pain management strategies, medications and coping strategies, combined with sessions of stretching, exercise and  relaxation techniques.

Led by Dr Charles Inderjeeth, a study that enrolled 202 people with AS in the program found that disease activity scores improved over 12 months, along with Quality of Life scores and  Bath Ankylosing Spondylitis Functional Index.

Participants reported less nocturnal back pain at six months and 12 months, as well as less fatigue and anxiety and depression.

The results are published in the International Journal of Rheumatic Disease

Will rheumatology patients respond to COVID19 vaccine?

A new study will investigate whether patients with conditions that affect the immune system such as auto-inflammatory disease will be well-protected by current COVID-19 vaccines.

The OCTAVE trial will enrol up to 5,000 people in the UK, and will compare immune responses to COVID-19 vaccination in those with cancer, inflammatory arthritis, liver or kidney diseases, or who have undergone a stem cell transplant with a control group of individuals without these conditions.

The results will be based on blood test-based measures of immune response taken before and after vaccination.

“Patients with significant underlying diseases were generally excluded from COVID-19 vaccine studies to date – it is now important to confirm that the COVID-19 vaccines work well in such conditions,” said Prof Pam Kearns, of the University of Birmingham’s Cancer Research UK Clinical Trials Unit.

“Current evidence shows that people with these medical conditions may not obtain optimal protection from established vaccines,” Prof Kearns said.

TNFi effective after first bDMARD failure in RA

Patients with RA may benefit from a TNF inhibitor rather than a second biologic after failure of a non-TNFi as first bDMARD, an international study has found.

Outcomes from 620 patients in Nordic countries who started a second bDMARD (rituximab, abatacept or tocilizumab) or TNFi following failure of a first non-TNFI bDMARD showed that  at 6 months less than one third of patients were still on their second bDMARD and had reached low disease activity or remission according to DAS28. 

However, for those patients whose second bMDARD was a TNFI, the corresponding proportion was slightly higher (40%).

“The survival-on-drug and primary response of a second bDMARD in RA patients switching due to failure of a non-TNFi bDMARD as first bDMARD is modest,” concluded researchers in the Journal of Rheumatology 


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