Tuesday, 8 November 2016

Update and highlights from EULAR Congress 2016 London

Update and highlights from EULAR 2016
I attended the European League Against Rheumatism (EULAR) Annual Congress in June 2016. This was held on home ground in London. This annual meeting brings together rheumatologists and allied health professionals from across the world.

There was a tweet up at EULAR 2016 and it was good meeting up face to face with colleagues and friends.
EULAR 2016 at the Excel Centre, London, UK

There were many abstracts presented at the meeting. See the EULAR website for the link to the abstracts.
Post EULAR, I have led a journal club and presented my highlights from the sessions at the conference. The following abstracts were my highlights of the meeting. You may wish to have a discussion with your team using these or other abstracts.
THU0058 (Tweehuysen L et al) – A systematic review looking at predictors of successful dose reduction or discontinuation of biologics in patients with RA. Over 3000 non-duplicate articles were included and biomarkers reviewed. Three predictors were identified for prediction of successful dose reduction and successful discontinuation of a biologic. These were higher adalimumab trough level for successful dose reduction; and lower Sharp/van der Heijde erosion score and shorter symptom duration at the start of a biologic for successful discontinuation.
OP0225 (Glintborg B et al) – Results from the Danish (DANBIO) registry showed that for patients with inflammatory arthritis (647 patients, 50% had RA and the other 50% were AS or PsA), a non-medical switch from infliximab (Remicade) to the biosimilar (Remsima) did not appear affect disease activity or risk of having a flare. This was up to 3 months and longer follow up will be interesting to assess this switch.
OP0182 (Gerlag D et al) – Results from the PRAIRI study (81 patients included) showed a single infusion of anti-CD20 antibody rituximab can delay the onset of rheumatoid arthritis for up to 1 year in individuals at risk of developing the condition. The participants have CCP and RF positivity, raised CRP and subclinical synovitis on ultrasound or MRI of hands.
OP0001 (Braun J et al) – Results from the MEASURE 1 trial looking at the radiographic change with the use of interleukin-17A inhibitor Secukinumab in ankylosing spondylitis. Secukinumab (both 75mg and 150mg doses) resulted in no radiographic progression in approximately 80% of patients over 104 weeks.
THU0158 (Frisell T et al) – The effect of baseline characteristics in channelling the choice of the second biologic after first anti-TNF failure in RA. Data from the Swedish Rheumatology Register from 2010-2012. The most common biologic after initial TNFi therapy were rituximab and etanercept. Those initiating a second TNFi were slightly younger, less often rheumatoid factor (RF) positive, and had slightly lower DAS28 than those initiating a non-TNFi biologic. Initiators of rituximab had longest disease duration, highest proportion RF+ and with history of malignancy or COPD, while etanercept-initiators had the lowest proportion with history of malignancy. Those initiating a second TNFi had more often switched due to adverse events.
OP0002 (van der Heijde D et al) – Results from the phase 2 study of the oral Janus kinase (JAK) inhibitor tofacitinib in ankylosing spondylitis. In this placebo-controlled double-blind study, the dose-response, efficacy and safety were evaluated. Patients were randomised to placebo, 2mg bd, 5mg bd and 10mg bd for 12 weeks. ASAS20 was achieved in 40.1%, 56.0%, 63.0%, 67.4% respectively. BASDAI50 was achieved in 23.5%, 46.2%, 42.3%, 42.3% respectively. There was no difference in the safety profile between any of the tofacitinib groups and the placebo group.
FRI0154 (Serhal L et al) – Looks at the effect on disease activity and function with failed anti-TNF dose reduction in rheumatoid arthritis. RA patients who failed dose reduction had higher DAS28 than those who were successful despite reintroduction of a standard dose of anti-TNF. Failed dose reduction did not appear to cause loss of functional capacity (HAQ) or a greater cumulative exposure to inflammation (AUCCRP) compared to successful reduction. The functional capacity (HAQ) at anti-TNF initiation appears to predict the likelihood of successful dose reduction. Non-reducers had a higher HAQ score (1.59) compared to failed dose reduction (1.28) and successful dose reduction (0.95). Following dose re-escalation, 32% had achieved DAS28 remission, 20% developed lower (LDA), 44% moderate (MDA) and 4% severe disease activity (SDA).
FRI0155 (Sigaux J et al) – Results from the STRASS trial showing that 50% of patients who tapered anti-TNF while in stable remission were able to maintain tapered regimen at 3 years. Maintenance of anti-TNF was high (68% at 3 years) in patients with established RA treated according to the treat-to-target paradigm, with no difference between the 2 initial RCT arms (S-arm, progressive injection spacing and M-arm (full regimen). More than 1/3 of patients received the tapered anti-TNF regimen.
FRI0447 (Kavanaugh A et al) – 3 year treatment data from the PALACE study of apremilast (APR) in patients with active PsA despite previous conventional disease-modifying antirheumatic drug (DMARD) or biologic therapy. 504 randomized patients received ≥1 dose of study medication (PBO: n=168; APR30: n=168; APR20: n=168). In an “as observed” analysis, 53.2% (APR30) and 59.6% (APR20) of patients achieved a modified ACR20 response at Wk 52. In year 2, 65.3% (APR30) and 60.9% (APR20) attained these responses at Wk 104. Patients receiving APR30 at Wk 156 demonstrated sustained improvements, as shown by ACR20 of 65%, swollen/tender joint count mean percent improvements of -81.2% and 73.2%, and HAQ-DI mean change of -0.37, and 41.9% of patients reaching DAS (CRP) <2.6. No new safety concerns were identified with up to 156 wks of APR treatment.
AB0324 (I’Ami MJ et al) – Interim analysis at Week 26 of tapering of Adalimumab based on therapeutic drug monitoring in rheumatoid arthritis. Patients with an adalimumab concentration >8 mL/L were randomly (1:1) assigned to continuation of adalimumab every other week (continuation group) or prolongation of the dosage interval to once every 3 weeks (tapering group), independently of disease activity score in 28 joints (DAS28). At 26 weeks, mean ΔDAS28 did not meet the criteria for a clinically relevant difference in both continuation group (0.29± 0.58 standard deviation (SD)) and tapering group (-0.06±0.58 SD) and did not significantly differ (p=0.06) between groups. This interim analysis shows that disease activity remains stable in RA patients with adalimumab concentrations >8 mL/L who prolonged their dose interval to once in the three weeks compared to patients who continued adalimumab every other week.

These were my highlights from EULAR 2016.

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