It’s difficult to highlight the most striking studies or topic areas out of the bounty of research that will be presented at the annual meeting of the American College of Rheumatology, but a few noteworthy studies caught the eye of Dr. Eric L. Matteson, the meeting’s planning subcommittee abstract selection cochair for clinical research.
Some of the studies and topic areas that deserve attention include growing knowledge about the risk of cardiovascular disease in many rheumatic conditions; the conditions in which rheumatoid arthritis (RA) treatment can be cost-effective, and de-escalation of disease-modifying antirheumatic drugs (DMARDs) may be possible; promising clinical results with new drug targets; according to Dr. Matteson, professor of medicine and chair of the department of rheumatology at the Mayo Clinic, Rochester, Minn.
Cardiovascular disease in spondyloarthritis, RA
Dr. Eric L. Matteson
“One major area in rheumatic diseases is looking at the emerging field of cardiovascular disease. We’ve known that there’s increased risk for heart disease in rheumatoid arthritis patients, not necessarily what to do about it. Now increasingly we’re finding that there’s the same risk in some other inflammatory arthritis diseases,” Dr. Matteson said. A Canadian study to be presented on Tuesday (abstract 2829) is the first population-based cohort study to show that patients with spondyloarthritis are at increased risk for heart disease, although at 40%-50% increased risk of cardiovascular death in comparison to people without spondyloarthritis, it is not at the same magnitude of risk as what is observed for RA, where risk for CV death is doubled in some subgroups, such as women with rheumatoid factor-positive disease.
“I think that’s something that’s new and is significant,” Dr. Matteson said.
Another interesting study to be reported on Sunday provides some initial evidence to suggest that reducing disease activity in RA might reduce the risk of heart failure, which has been shown to be elevated in RA patients. The prospective, cross-sectional study (abstract 945) of patients from a clinic in Germany found progressively lower prevalence of heart failure as 28-joint Disease Activity Score declined, independent of treatment type.
De-escalating DMARDs in RA
Another “hot-button” issue in RA is whether it is possible to reduce therapy, Dr. Matteson noted. On Sunday, German investigators will present a multicenter, randomized controlled trial (abstract 940) showing that while DMARDs can be successfully de-escalated, it’s not clear whether starting the de-escalation process is better done first with a conventional DMARD or a biologic. The presence of anticitrullinated peptide antibodies turned out to be the only predictor of recurrent disease. Another study in the same session (abstract 941) indicated that an attempt to de-escalate biologic treatment was successful in 87% of the selected patients who tried to do so and provided substantial cost savings.
New drug targets in clinical research
One of the unique therapeutic approaches being tried is using autologous dendritic cell immunotherapy to treat RA patients, Dr. Matteson said. “The dendritic cell is an important immune-mediating cell actually not just in rheumatoid arthritis but a lot of other systemic inflammatory conditions including even giant cell arteritis.” A phase I, open-label study (abstract 946) that will be presented on Sunday demonstrated that five vaccinations with high or low doses of the cells over 2- to 4-week intervals in 12 RA patients yielded good to moderate European League Against Rheumatism (EULAR) responses in 7 patients while 12 adverse events occurred in 8 patients.
After not-so-encouraging studies of interleukin-17 as a drug target in RA, its potential in seronegative inflammatory arthritis appears much more promising. The results of a 1-year, phase III trial of secukinumab, a monoclonal antibody to IL-17A, in patients with psoriatic arthritis is “quite hopeful” because there were improvements in clinical parameters of disease and an indication of inhibition of joint erosion (abstract 954). Another phase III study of the drug showed “quite promising effects” in controlling ankylosing spondylitis over the course of 1 year (abstract 819). Both studies will be presented on Sunday.
Noteworthy plenary presentations
“One of the hot areas in lung disease in rheumatic diseases” involves controversy over the value of lung transplantation in patients with systemic sclerosis (SSc) and end-stage lung disease, Dr. Matteson said. A study to be presented in Monday’s plenary session suggests that new methods must be developed to determine which SSc patients can successfully undergo lung transplantation rather than to deny all patients with the condition the chance to undergo the procedure. While the study (abstract 1797) confirmed that patients with SSc have a nearly 50% increased risk of death at 1 year posttransplant when compared with interstitial lung disease patients without SSc, there was no difference in mortality for SSc patients, compared with patients with pulmonary arterial hypertension not caused by SSc.