News in brief: Tofacitinib looks promising in AS; Call to curb spinal procedure for LBP; Rituximab improves neuro-psychiatric lupus

Thursday, 6 May 2021

Promise for JAK inhibition in AS

The JAK inhibitor tofacitinib keeps on giving – now demonstrating significantly greater efficacy versus placebo in adults with active ankylosing spondylitis.

A phase 3 RCT of 269 patients found the ASAS20 response rate at week 16 with 5mg tofacitinib was 56.4% versus 29.4% in controls (p<0.0001) and ASAS40 response rates were 40.6% v 12.5% respectively (p<0.0001).

In an open-label phase from weeks 16-48, ASAS20/ASAS40 response rates remained stable over time.

Rates of adverse events were similar with tofacitinib and placebo (54.9% v 51.5%) as were serious adverse events (1.5% v 0.7%). No new potential safety risks were identified up to the end of study treatment at week 48.

The international study conducted across 14 countries included a number of Australian sites.

Annals of Rheumatic Diseases

Report puts spotlight on inappropriate lumbar spinal surgery

New evidence-based pathways for the management of low back pain should be implemented to address inappropriate use of lumbar spinal fusion and decompression surgery, according to the Australian Commission on Safety and Quality in Health Care

In its latest Atlas of Healthcare Variation it found that rates of lumbar spinal fusion were up to 12 times higher in some geographic than others. Similarly, in 2015–2018 the rate of hospitalisation for lumbar spinal decompression was about eight times higher in the local area with the highest rate than in the area with the lowest.

The report noted a 4% fall in the national rate of lumbar spinal fusion, and a 25% fall in the rate of lumbar spinal fusion excluding decompression, between 2012–2015 and 2015–2018.

The report recommended implementation of pathways and services to prioritise non-surgical treatments for chronic low back pain, and to develop the Australian Spine Registry to collect data on patient outcomes and support audit and peer review.

Rituximab offers improvements in neuro-psychiatric lupus

Treatment with rituximab was associated with improvement in neuro-psychiatric (NP) involvement in systemic lupus erythematosus (SLE), and concomitant cyclophosphamide may enhance the improvement further, according to a new study.

NP involvement in SLE can occur in more than half of cases. In the trial of 74 patients included in the British Isles Lupus Assessment Group Biologics Register (BILAG-BR), scores measuring NP involvement improved significantly after rituximab use (p < .0001).

Treatment with rituximab also resulted in a reduction in steroid use, from a median of 15 mg to 10 mg (p = .009).

Among nine patients treated with concomitant cyclophosphamide, none had persistent NP disease, while 11 of 41 treated with rituximab alone did.

“Larger scale studies are warranted to establish the effectiveness of rituximab alone or in combination with cyclophosphamide in the treatment of neuro-psychiatric lupus,” said Dr Trixy David, of the University Manchester.

The findings were presented at the British Society for Rheumatology’s 2021 Annual Conference was held 26-28 April.

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