News in brief: What future for COVID-19 Global Rheumatology Alliance? csDMARD/TNFi comedication improves PsA remission rates; Rebound fractures after stopping denosumab

What next for COVID-19 Global Rheumatology Alliance? Take the survey

More than a year after its inception, the COVID-19 Global Rheumatology Alliance is looking to the future and seeking ideas from health professionals about what the Alliance could become after the need to address the pandemic has receded. The grassroots initiative of clinical and academic rheumatologists was set up in March 2020 in response to the global COVID-19 pandemic, with the goal of rapidly curating and disseminating accurate, timely, evidence-based information to advance rheumatology care during the pandemic.

Now the Alliance, chaired by Dr Philip Robinson, a rheumatologist at the Royal Brisbane Hospital, is posing the question: “Think about what could be done with the GRA structure, people or philosophy that is not being done now and solves a problem or adds value?”

If you have ideas about what projects or problems the GRA could tackle you can share them here.

csDMARD and TNFi co-medication associated with improved PsA remission rates

Combining a csDMARD with a TNFi was more effective than a TNFi monotherapy in patients with PsA according to a large European registry study. However, the beneficial effect was not seen across all comedication combinations.

A retrospective review of more than 15,000 patients with PsA  from across 13 European countries who had initiated a first ever TNFi showed the strategy of comedication with methotrexate in patients treated with adalimumab or infliximab was associated with a 50% increase in the probability of achieving Disease Activity Score with 28 joints (DAS28) remission at 1 year, compared with TNF-inhibitor monotherapy.

But comedication with csDMARDs in patients treated with etanercept provided no additional advantage over TNF-inhibitor monotherapy in terms of either retention or DAS28 remission rates, say investigators from the Department of Rheumatology and Inflammation Research at the University of Gothenburg in Sweden.

In a situation of incomplete response, they say the findings support ‘the prevailing strategy to continue methotrexate therapy when commencing treatment with infliximab or adalimumab, while for etanercept methotrexate may be discontinued’.

The finding are published in Ann. Rheum Dis

Risk of rebound fractures defined after stopping denosumab

The risk of  rebound vertebral fractures after discontinutation of denosumab is  poorly predictable before the start of therapy, a Swiss study has shown. But there is significant predictive value from bone resorption markers and low total hip BMD during and after treatment, according to data derived from 797 female patients who received an average of six injections of denosumab over three years.

The vertebral fracture risk in the two years after denosumab discontinuation was close to 10% and was increased in patients who experienced non-vertebral fractures, the study showed. Bisphosphonates given after denosumab treatment decreased vertebral fracture risk, but bisphosphonates given before denosumab did not provide an additional benefit.

The findings are published in the Journal of Bone and Mineral Research

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