Anifrolumab Tied to Less Organ Damage for Patients With Lupus
For patients with moderately to severely active systemic lupus erythematosus (SLE), anifrolumab is associated with less organ damage after 208 weeks compared with patients receiving standard of care (SOC), according to a study published online Feb. 7 in the Annals of Rheumatic Disease.
Zahi Touma, M.D., Ph.D., from the University Health Network in Toronto, and colleagues examined whether anifrolumab plus SOC is associated with reduced organ damage accumulation compared with SOC only among adults with moderately to severely active SLE. The anifrolumab arm included patients who initiated 300 mg anifrolumab in the Treatment of Uncontrolled Lupus via the Interferon Pathway trials; real-world (RW) external controls from the University of Toronto Lupus Clinic cohort received SOC only (354 and 561 patients, respectively).
The researchers found that the mean change in Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) score was 0.416 points lower in the anifrolumab versus the RW SOC arm after weighting. The likelihood of experiencing an increase in SDI within 208 weeks was lower for patients in the anifrolumab arm (hazard ratio, 0.401).
"In addition to the proven effectiveness of anifrolumab for controlling disease activity, attaining Lupus Low Disease Activity State and remission, and enabling glucocorticoid tapering, this study shows that anifrolumab is effective for preventing long-term organ damage compared to RW SOC," the authors write.
Several authors disclosed ties to pharmaceutical companies, including AstraZeneca, which manufactures anifrolumab and funded the study.
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Gout Flares Often Underreported in U.S. Adults With Gout
Gout flares are commonly underreported among U.S. adults with gout, according to a study published in the January issue of ACR Open Rheumatology.
Jasvinder A. Singh, M.D., M.P.H., from the Michael E. DeBakey Veterans Affairs Medical Center in Houston, and colleagues assessed the burden of gout flares and examined associated patient characteristics and outcomes among 933 U.S. adults.
The researchers found that the total gout flare burden for those with gout was 6.6 gout flares per year. Nearly three-fourths of gout flares (72 percent) were either not reported to physicians or pretreated or prevented. Those who were less likely to report gout flares included those who were younger, were less educated, had a lower Charlson Comorbidity Index score, were not diagnosed with gout by their doctor, and were not taking a urate-lowering therapy.
"In this study, we obtained an estimate of gout flares and associated patient disease burden. We found that most gout flares were underreported, that is, only one-third of all gout flares are reported to the physicians," the authors write. "Several study findings merit further discussion because they provide new insights into the impact of gout on people's lives."
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Postmenopausal Women Have Higher Risk for Developing Rheumatoid Arthritis
Postmenopausal women, particularly those who experience early menopause, may have a higher risk for developing rheumatoid arthritis (RA), according to a review published online Sept. 30 in BMC Rheumatology.
Negin Namavari, M.D., from the School of Medicine at Peymaniye Hospital and the Jahrom University of Medical Science in Iran, and colleagues conducted a systematic literature review and meta-analysis to assess the association between menopause and RA. Eleven studies were included in the meta-analysis.
The researchers found that postmenopausal women had a higher risk for developing RA versus premenopausal women (odds ratio, 1.35). Women who experienced early menopause (before 45 years of age) showed significantly higher odds of developing RA than those who underwent menopause at a normal age (odds ratio, 2.97).
"These findings underscore the importance of menopausal status as a potential risk factor for RA, with the substantial increase in RA risk associated with early menopause warranting particular attention from both clinicians and researchers," the authors write. "Our results suggest several avenues for future research, including investigation into the biological mechanisms underlying the association between menopause and RA risk, development of targeted preventive strategies for postmenopausal women (especially those who experience early menopause), and exploration of potential interventions to mitigate RA risk in these higher-risk groups."
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Socioeconomic Factors May Not Predict Rheumatoid Arthritis Disease Activity
The impact of socioeconomic factors on disease activity in rheumatoid arthritis (RA) varies by academic or safety net hospital setting, according to a study published online Oct. 18 in ACR Open Rheumatology.
Joseph Kim, M.D., from the University of Texas Southwestern Medical Center in Dallas, and colleagues analyzed the impact of the Area Deprivation Index (ADI) on disease activity and cardiovascular comorbidity in RA. The analysis included data from 542 patients seen at an academic practice and 496 treated at a safety net hospital.
The researchers found that in the academic cohort, compared with those with low ADI scores (<3, less deprivation), those with high ADI scores (>8, more deprivation) had higher RA disease activity scores, as measured by the Routine Assessment of Patient Index and the Clinical Disease Activity Index, and more functional impairment, as measured by the Multidimensional Health Assessment Questionnaire, lower MyChart use, and different smoking history. The only significant difference seen in the safety net cohort was for smoking status.
"The absence of differences in RA disease activity and functional impairment in patients suggests that the ADI may not be as effective at predicting RA disease activity specifically in a safety net health care context," the authors write. "Identifying the discrepancies between the two systems may elucidate areas of improvement for patient care."
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American College of Rheumatology, Nov. 14-19
The annual meeting of the American College of Rheumatology was held this year from Nov. 14 to 19 in Washington, D.C., and attendees included rheumatology specialists, physicians, scientists, and other health professionals. The conference featured presentations focusing on the latest advances in the diagnosis and treatment of arthritis as well as other rheumatic and musculoskeletal diseases.
During one presentation, Chuan-Ju Liu, Ph.D., of the Yale University School of Medicine in New Haven, Connecticut, discussed how the sodium channel Nav1.7 represents a novel and actionable target to preserve joint structure and slow osteoarthritis progression, addressing not only pain but also structural deterioration.
Liu highlighted recent discoveries linking sodium channel Nav1.7 to the regulation of joint structure in osteoarthritis. He outlined how sodium channels in chondrocytes play a critical role in maintaining cartilage integrity and how targeting these channels could mitigate cartilage degeneration.
"Preclinical studies demonstrated that modulating Nav1.7 can prevent joint deterioration, suggesting a promising therapeutic approach," Liu said. "Although still in the early stages, this research points toward the potential for developing sodium channel inhibitors or modulators as disease-modifying treatments for osteoarthritis. Over time, this approach may complement or reduce reliance on existing treatments like nonsteroidal anti-inflammatory drugs, which primarily address symptoms and often have side effects."
In another presentation, Daniel Clauw, M.D., of the University of Michigan in Ann Arbor, discussed cannabis therapy for chronic pain among patients with rheumatic diseases.
Currently, there are very few randomized clinical trials evaluating the effectiveness and safety of cannabis products. In addition, the results of these studies can vary based on dose, mode of administration, and an individual's metabolism. It is also difficult to determine how much cannabidiol (CBD) and tetrahydrocannabinol (THC) are contained within cannabis products. However, Clauw stressed that cannabis can still be a relatively safe and effective option for the treatment of chronic pain.
"Cannabis products likely have a role in treating pain but more research needs to be done regarding what cannabis products work for what types of pain," Clauw said. "We know that CBD is quite safe and legal in all of the United States and people should try that before venturing to THC, which may be helpful in some but has far more potential side effects."
Lihi Eder, M.D., of the Women's College Hospital and University of Toronto, discussed how understanding sex-related differences in psoriatic arthritis is critical to developing approaches that consider the sex of the patient in disease management.
Male and female patients with psoriatic arthritis may present differently, with female patients having more pain and disability and a lower response to biologic therapies compared with their male counterparts. Eder said that the mechanisms behind these findings remain unclear, but the differences could be related to biological mechanisms such as pain processing, immune function, and the pharmacokinetics of drugs. They could also be due to sociocultural factors, including coping mechanisms, support systems, and access to care.
"Considering sex/gender in patient care could improve outcomes. For example, use of more sensitive imaging such as ultrasound to investigate the source of pain may be more important in females and could provide insights about the cause of pain and inform therapy," Eder said. "More research is needed to identify mechanisms for the observed differences."
ACR: Inebilizumab Reduces Risk for Flares in IgG4-Related Disease
TUESDAY, Nov. 19, 2024 (HealthDay News) -- For patients with immunoglobulin G4-related disease, inebilizumab reduces the risk for flares and increases the likelihood of flare-free complete remission, according to a study published online Nov. 14 in the New England Journal of Medicine to coincide with the annual meeting of the American College of Rheumatology, held from Nov. 14 to 19 in Washington, D.C.
ACR: Colchicine No Benefit for Painful Knee Osteoarthritis
TUESDAY, Nov. 19, 2024 (HealthDay News) -- Colchicine fails to improve knee pain, function, or size of synovial effusions with painful knee osteoarthritis, according to a study presented at the annual meeting of the American College of Rheumatology, held from Nov. 14 to 19 in Washington, D.C.
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ACR: Colchicine No Benefit for Painful Knee Osteoarthritis
Colchicine fails to improve knee pain, function, or size of synovial effusions with painful knee osteoarthritis (OA), according to a study presented at the annual meeting of the American College of Rheumatology, held from Nov. 14 to 19 in Washington, D.C.
Jonathan Samuels, M.D., from NYU Langone in Rye Brook, New York, and colleagues assessed whether daily colchicine improves pain, function, and synovial effusion size in patients with knee OA. The analysis included 120 participants with painful knee OA and radiographic Kellgren-Lawrence (KL) grades 2 or 3 who were randomly assigned to daily colchicine or placebo (1:1) for 12 weeks.
From baseline to end of treatment for the two groups, the researchers found no significant between-group differences in mean changes of visual analog scale (VAS) pain, Knee Osteoarthritis Outcome Score subscores, or sonographic size of synovial effusions in millimeters. In a per-protocol study completer subset analysis, findings persisted. No significant benefit was detected in subsets of patients with greater baseline inflammation or more severe VAS pain or radiographic KL severity. Acetaminophen use, which was allowed as needed, was not taken less often by patients assigned to colchicine.
"Whether longer treatment with colchicine, higher doses, or a larger cohort would improve pain and function or modify radiographic progression remains to be determined," the authors write.
Two authors disclosed ties to the pharmaceutical industry.
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ACR: Inebilizumab Reduces Risk for Flares in IgG4-Related Disease
For patients with immunoglobulin G (IgG)4-related disease, inebilizumab reduces the risk for flares and increases the likelihood of flare-free complete remission, according to a study published online Nov. 14 in the New England Journal of Medicine to coincide with the annual meeting of the American College of Rheumatology, held from Nov. 14 to 19 in Washington, D.C.
John H. Stone, M.D., M.P.H., from Massachusetts General Hospital in Boston, and colleagues conducted a phase 3, multicenter, double-blind, randomized trial involving adults with active IgG4-related disease. A total of 135 participants were randomly assigned to receive inebilizumab (300-mg infusions on days 1 and 15 and week 26) or placebo (68 and 67 participants, respectively). In both groups, participants received identical glucocorticoid tapers.
The researchers found that flare risk was reduced with inebilizumab treatment: 10 and 60 percent of participants in the inebilizumab and placebo groups had at least one flare, respectively (hazard ratio, 0.13). A lower annualized flare rate was seen with inebilizumab than placebo (rate ratio, 0.14). Flare-free, treatment-free complete remission and flare-free, glucocorticoid-free complete remission occurred in more participants in the inebilizumab group than the placebo group (odds ratios, 4.68 and 4.96, respectively). During the treatment period, serious adverse events occurred in 18 and 9 percent of participants receiving inebilizumab and placebo, respectively.
"The magnitude and consistency of the efficacy results suggest inebilizumab as a treatment option for patients with IgG4-related disease," the authors write.
The study was funded by Amgen, the manufacturer of inebilizumab.
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Anxiety/Depression Linked to HRQoL Losses in Seropositive RA
Patients with seropositive rheumatoid arthritis (RA) with moderate and extreme anxiety/depression have mean health-related quality-of-life (HRQoL) losses, regardless of pain and discomfort, according to a study published online Oct. 30 in Clinical Rheumatology.
Diego Fernando Rojas‑Gualdrón, from the Universidad CES in Medellín, Colombia, and colleagues conducted a data analysis on a registry-based retrospective follow-up study of patients with seropositive RA treated between August 2014 and January 2023. The authors sought to examine the HRQoL loss associated with self-perceived anxiety/depression. A total of 3,579 patients were included, with a mean follow-up of 2.9 years.
The researchers found that 6.6 percent of the participants reported extreme anxiety/depression at program admission. Per year lived with seropositive RA, the average HRQoL loss was 3.4 months. Moderate and extreme anxiety/depression were associated with mean HRQoL losses of 2.2 and 4.1 months, respectively, among patients with no pain and discomfort, and with losses of 0.8 and 1.9 months, respectively, for patients with extreme pain/discomfort.
"These findings highlight the importance of strengthening mental health care and psychological well-being interventions for patients with RA, regardless of pain or disease activity," the authors write.
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Early Rheumatoid Arthritis Tied to Hypertension
Patients with early rheumatoid arthritis (RA) have a high incidence of prevalent and incident hypertension, according to a study published online in the August issue of Rheumatology: Advances in Practice.
Brook Hadwen, from the University of Western Ontario in London, Canada, and colleagues used data from the Canadian Early Arthritis Cohort to explore the prevalence and incidence of hypertension and baseline factors associated with incident hypertension in early RA (2,052 patients).
The researchers found that the prevalence of hypertension at study enrollment was 26 percent (23 percent in women and 34 percent in men). Prevalent hypertension was associated with older age, diabetes, and hyperlipidemia in both sexes. In women, hypertension was associated with being overweight or with high alcohol consumption. One quarter (24 percent) of the RA patients did not have hypertension at enrollment but developed hypertension during the median follow-up period of five years. Incident hypertension was significantly associated with the baseline factors of older age, being overweight, excess alcohol consumption, and having hyperlipidemia. There were no significant associations between RA-associated disease factors and treatments with prevalent or incident hypertension.
"Weight loss and lifestyle modifications such as changes in diet, exercise, and limiting alcohol intake may reduce the risk of high blood pressure and prevent heart disease," the authors write.
Several authors disclosed ties to the pharmaceutical industry.
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Rheumatoid Arthritis Tied to Heavy Economic and Human Burdens
Rheumatoid arthritis (RA) is associated with higher health care expenditures and suboptimal quality of life in U.S. adults, according to a study published online Aug. 6 in ACR Open Rheumatology.
Yinan Huang, Ph.D., from the University of Mississippi in Oxford, and colleagues estimated the economic and humanistic burden of RA among U.S. adults using self-reported data from the Medical Expenditure Panel Survey (2018 to 2020).
The researchers found significantly higher total annual health care expenditures in the RA group versus the non-RA group (mean, $3,382.971). The RA group also had lower Short Form 12 Health Survey physical component summary scores (mean, 4.78) and lower mental component summary scores (mean, −0.84). Compared with the non-RA group, the RA group also had increased odds of requesting assistance with activities of daily living (adjusted odds ratio, 2.02) and instrumental activities of daily living (adjusted odds ratio, 2.11).
"RA was associated with higher health care expenditures, particularly prescription medication costs, and was associated with suboptimal quality of life," the authors write. "Prescribers should evaluate the health-related quality-of-life impact in prescribing treatment to adults with RA. Managed care professionals and payers should be aware of the high expenditures of RA due to high-cost prescription medications."
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Lung Complications + Rheumatoid Arthritis Increase Risk for Lung Cancer
The risk for lung cancer is high in patients with rheumatoid arthritis (RA) and pulmonary complications, according to a study published online Sept. 3 in Modern Rheumatology.
Shunsuke Mori, M.D., Ph.D., from the Kumamoto Saishun Medical Center in Koshi, Japan, and colleagues assessed the incidence and predictive factors of lung cancer in people with RA. The analysis included 771 patients who were diagnosed with RA at a single institution between April 2001 and December 2022.
The researchers found that 3.5 percent of patients were diagnosed with combined pulmonary fibrosis and emphysema (CPFE), 4.9 percent with interstitial lung disease (ILD) alone, and 6.0 percent with emphysema alone. During a mean of 9.3 years, the crude incidence rates of lung cancer were 2.9, 47.8, 10.5, 11.9, and 0.8 per 1,000 patient-years in all patients, CPFE patients, ILD patients, emphysema patients, and patients without these complications, respectively. Compared with the general population, the standardized incidence ratios (95 percent confidence intervals) were 2.53 (1.29 to 3.77) for male patients and 0.89 (0.57 to 1.16) for female patients. The risk for lung cancer was found to be higher across conditions versus that seen in patients without complications (adjusted hazard ratios [95 percent confidence intervals], 13.48 [3.14 to 57.85] for CPFE, 6.42 [1.42 to 29.09] for ILD alone, and 4.65 [1.18 to 18.30] for emphysema alone).
"Close monitoring of lung cancer is needed for RA patients with smoking history and pulmonary complications, especially CPFE," the authors write.
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Rheumatoid Arthritis Tied to Higher Risk for Lung Cancer
Rheumatoid arthritis (RA) is associated with a significantly increased risk for lung cancer, according to a study published online July 28 in Arthritis & Rheumatology.
Rebecca T. Brooks, M.D., from the Mayo Clinic in Rochester, Minnesota, and colleagues evaluated lung cancer risk in people with RA and RA-interstitial lung disease (ILD). The analysis included 72,795 Veterans Health Administration patients with RA and 633,937 matched non-RA persons.
The researchers found that RA was independently associated with an increased lung cancer risk (adjusted hazard ratio [aHR], 1.58), which persisted in never-smokers (aHR, 1.65) and incident RA (aHR, 1.54). Prevalent RA-ILD (757 patients) was more strongly associated with lung cancer risk (aHR, 3.25) than RA without ILD (aHR, 1.57) compared with non-RA controls. Results were similar for both prevalent and incident RA-ILD (RA-ILD versus non-RA: aHR, 2.88).
"RA was associated with a >50 percent increased risk of lung cancer, and RA-ILD represented a particularly high-risk group with an approximate threefold increased risk," the authors write. "Increased lung cancer surveillance in RA, and especially RA-ILD, may be a useful strategy for reducing the burden posed by the leading cause of cancer death."
Several authors disclosed ties to the pharmaceutical industry.
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Depression, Anxiety, Fibromyalgia Common With Rheumatoid Arthritis, Osteoarthritis
Approximately four in 10 patients with osteoarthritis (OA) or rheumatoid arthritis (RA) have anxiety, depression, or fibromyalgia, according to a study published online July 16 in ACR Open Rheumatology.
Juan Schmukler, M.D., from the Rush University Medical Center in Chicago, and colleagues analyzed the prevalence of anxiety, depression, and fibromyalgia in 361 patients with OA versus 488 patients with RA seen in routine care.
The researchers found that 40.4 percent of patients with OA and 36.3 percent of 488 patients with RA screened positive for anxiety, depression, or fibromyalgia. Eight and 7 percent of patients with OA and RA, respectively, screened positive for all three. Poorer patient status (as measured by the Routine Assessment of Patient Index Data 3 [RAPID3]) overall, as well as each component, were significantly higher in patients with any positive screen result in both diagnoses (odds ratios of 2.6 to 35.8).
"Screening for anxiety, depression, and/or fibromyalgia can be incorporated feasibly into routine clinical care using a single MDHAQ [Multidimensional Health Assessment Questionnaire] to better inform health professionals concerning patient status, prognosis, and response to treatments," the authors write.
One author disclosed ties to the pharmaceutical industry; one author holds a copyright and trademark on MDHAQ and RAPID3.
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Scientists Spot Cause of Lupus, Way to Reverse It
Lupus is caused by a specific defect in the immune system that can be reversed, potentially curing the autoimmune disorder, a new study claims.
The disease appears to be caused by malfunctions in an immune system pathway that regulates cells’ response to environmental pollutants, bacteria and toxins.
Insufficient activation of this pathway, controlled by the aryl hydrocarbon receptor (AHR), results in an overproduction of immune cells that attack the body itself rather than foreign invaders, researchers said.
By fully activating this immune system response, “we can reduce the number of these disease-causing cells,” said researcher Dr. Jaehyuk Choi, an associate professor of dermatology at Northwestern University Feinberg School of Medicine.
“If these effects are durable, this may be a potential cure,” Choi added in a Northwestern news release.
Lupus occurs when the immune system turns on the body, causing systemic inflammation that can result in life-threatening damage to organs like the kidneys, heart and brain.
Existing treatments have focused on suppressing the immune system, which left patients vulnerable to dangerous infections.
“Up until this point, all therapy for lupus is a blunt instrument. It’s broad immunosuppression,” Choi said. “By identifying a cause for this disease, we have found a potential cure that will not have the side effects of current therapies.”
To test if this pathway drives lupus, researchers tested AHR-activating drugs on blood samples taken from lupus patients.
This treatment seemed to reprogram the lupus-causing cells into cells that might instead promote wound healing, researchers reported July 10 in the journal Nature.
“We’ve identified a fundamental imbalance in the immune responses that patients with lupus make, and we’ve defined specific mediators that can correct this imbalance to dampen the pathologic autoimmune response,” researcher Dr. Deepak Rao, a rheumatologist at Brigham and Women’s Hospital in Boston, said in a news release.
The next step is to use this knowledge to make new treatments for lupus patients using AHR-activating drugs, researchers said.
More information
The Lupus Foundation of America has more about lupus.
SOURCE: Northwestern University, news release, July 10, 2024
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Air Pollutant Exposure Linked to Increased Risk for Incident Lupus
Air pollutant exposure is associated with an increased likelihood of developing incident systemic lupus erythematosus (SLE), according to a study published online July 10 in Arthritis & Rheumatology.
Meiqi Xing, from the Huazhong University of Science and Technology in Wuhan, China, and colleagues examined the associations between long-term exposure to air pollutants and incident SLE using data from 459,815 participants from the U.K. Biobank. For further assessing the interactions and joint effects of genetic risk and air pollutants, the polygenic risk score was used.
During a median follow-up of 11.77 years, 399 patients with SLE were identified. The researchers identified positive associations between air pollutant exposure and incident SLE, with adjusted hazard ratios of 1.18, 1.23, 1.27, and 1.13 for each interquartile range increase in particulate matter with a diameter ≤2.5 µm (PM2.5), PM10, nitrogen dioxide (NO2), and nitrogen oxides (NOx), respectively. Compared with those with low genetic risk and low air pollution exposure, participants with high genetic risk and high air pollution exposure had the highest risk for incident SLE (adjusted hazard ratios, 4.16, 5.31, 5.61, and 4.80 for PM2.5, PM10, NO2, and NOx, respectively). A significant multiplicative interaction was seen between NO2 and polygenic risk score.
"Our study provides crucial insights into the air pollution contributing to autoimmune diseases," coauthor Yaohua Tian, Ph.D., also of the Huazhong University of Science and Technology, said in a statement. "The findings can inform the development of stricter air quality regulations to mitigate exposure to harmful pollutants, thereby reducing the risk of lupus."
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RA Patients With Mono-, Oligo-Arthritis, High PGA Remain Most Fatigued
Rheumatoid arthritis (RA) patients with mono- or oligo-arthritis and high Patient Global Assessment (PGA) at diagnosis remain the most fatigued, according to a study published in the June issue of Rheumatology.
Anna M.P. Boeren, from the Leiden University Medical Center in the Netherlands, and colleagues studied Disease Activity Score (DAS) components at diagnosis in relation to the course of fatigue over a five-year period in two early RA cohorts. Data were included for 1,560 RA patients in the Leiden Early Arthritis Cohort and 415 in the tREACH cohort. Swollen joint count, tender joint count, erythrocyte sedimentation rate, and PGA (on a visual analogue scale) were assessed in relation to fatigue.
The researchers found that a more severe course of fatigue was seen in association with higher tender joint count and higher PGA at diagnosis. Mono- or oligo-arthritis at diagnosis was associated with patients remaining more fatigued. In contrast, there was an inverse association seen for the swollen joint count. Patients presenting with mono- or oligo-arthritis and PGA ≥50 mm remained the most fatigued over time (+20 mm versus polyarthritis with PGA <50 mm) on examination of combinations of characteristics, while no difference was seen for the DAS course over time. Fourteen percent of the early RA population were part of this subgroup. Similar findings were seen in the tREACH trial.
"Future studies on the efficacy of additional nonpharmacological treatments, such as cognitive behavioral therapy, preferentially within this subgroup of RA patients, are needed, because these patients have the highest unmet need," the authors write.
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hs-cTnT Linked to MACE, Mortality in Rheumatoid Arthritis
For patients with rheumatoid arthritis (RA), a detectable level of high-sensitivity cardiac troponin T (hs-cTnT) is associated with increased risk of major adverse cardiovascular events (MACE) and all-cause mortality, according to a research letter published online June 15 in the Journal of Rheumatology.
Brittany N. Weber, M.D., Ph.D., from Brigham and Women's Hospital in Boston, and colleagues examined the longer-term association between clinically established thresholds for detectable hs-cTnT with MACE (acute coronary syndrome, stroke, and cardiovascular death) and all-cause mortality among 331 patients with RA.
The median calculated 10-year atherosclerotic cardiovascular disease (ASCVD) risk was 3.87 percent. The researchers found that 117 patients (35.3 percent) had detectable hs-cTnT (median level, 8.98 mg/dL). In 10 years, 16 MACE occurred (4.8 percent), with 50 all-cause deaths (15.1 percent). There was an association seen for detectable hs-cTnT with future MACE (hazard ratio [HR], 7.13); the significant association persisted after adjustment for ASCVD risk and log high-sensitivity C-reactive protein (hsCRP; HR, 4.29) and for baseline ASCVD risk and Disease Activity Score in 28 joints based on CRP (DAS28-CRP). Corresponding associations were seen for detectable hs-cTnT and all-cause mortality (HR, 7.2), which also persisted after adjustment (HRs, 4.18 and 4.74, respectively). ASCVD risk score alone was significantly associated with MACE.
"These findings suggest that hs-cTnT may be a useful marker to improve cardiovascular risk assessment among patients with RA with overall low estimated ASCVD risk," the authors write.
Several authors disclosed ties to the pharmaceutical industry.
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FDA Expands Pediatric Indication for Rinvoq
The U.S. Food and Drug Administration has expanded indications for Rinvoq (upadacitinib) to now include pediatric patients (ages 2 years and older) with polyarticular juvenile idiopathic arthritis (pJIA) and psoriatic arthritis (PsA).
Rinvoq is indicated for pediatric patients with an inadequate response or intolerance to one or more tumor necrosis factor (TNF) blockers. In addition, Rinvoq LQ, a new weight-based oral solution, is available for these pediatric patients.
The expanded indication is based on pharmacokinetic data from 51 patients with pJIA with active polyarthritis and safety data from 83 patients with pJIA with active polyarthritis. At the recommended doses, upadacitinib plasma exposures in pediatric patients with pJIA and PsA are expected to be comparable to those observed in adults with rheumatoid arthritis and PsA based on population pharmacokinetic modeling and simulation.
"Pediatric patients with pJIA and PsA can be severely limited in their ability to complete daily physical tasks and participate in everyday activities. Understanding their needs today and knowing the likelihood of disease in adulthood underscores the need for additional treatment options," Aarat Patel, M.D., from the Bon Secours Rheumatology Center of St. Mary’s Hospital in Richmond, Virginia, said in a statement. "Having a treatment option available for patients who do not respond well to a TNF inhibitor addresses a need for the health care community, patients, and their families."
Expanded approval of Rinvoq was granted to AbbVie.
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