The edition · Rheumatology
People with lupus had about two and a half times the risk of stroke, ischaemic and haemorrhagic alike
A meta-analysis of stroke risk in SLE closes the edition. Before it: how little trial evidence supports fracture prevention drugs in men, MRI and radiographic outcomes with bimekizumab in axial spondyloarthritis, difficult-to-manage psoriatic arthritis in Nordic registries, and an FDA supplement for a tocilizumab biosimilar.
The edition in brief
A meta-analysis of 25 cohort studies with 5.2 million people found SLE associated with a higher risk of stroke (RR 2.60, 95% CI 2.21–3.05), both ischaemic (2.34) and haemorrhagic (2.66). Heterogeneity was very high, but sensitivity analyses held, and the practical point is that stroke prevention in lupus needs active attention to antiphospholipid antibodies, blood pressure, lipids and smoking. A Cochrane review of 17 trials in 4,132 men aged 50 and over found the effect of bisphosphonates on fractures very uncertain at up to two years because events were rare (vertebral fractures 4 vs 8 per 1,000; RR 0.49, 0.14–1.74), with similar uncertainty for teriparatide-class drugs, denosumab and romosozumab; bisphosphonates probably did not increase adverse events. In BE MOBILE 1 and 2, bimekizumab reduced sacroiliac joint and spinal inflammation on MRI by week 52, with falling erosion scores and minimal radiographic progression to week 104 in observed cases. Across five Nordic registries, 36% of 14,362 people with psoriatic arthritis stopped two or more biologic or targeted drugs, but only 2% met difficult-to-manage and 1.2% treatment-refractory criteria; these patients were more often women with depression and opioid use. The FDA recorded a supplement to Celltrion's tocilizumab biosimilar Avtozma; the record does not state its content and it is not a new indication. The pearl: test antiphospholipid antibodies in every patient with lupus.
Trial evidence that osteoporosis drugs prevent fractures in men is very uncertain
Keep treating men at high fracture risk, but tell them the fracture benefit is extrapolated from trials in women.
Bimekizumab reduced MRI inflammation and erosions in axial spondyloarthritis, with minimal radiographic progression to two years
Bimekizumab quiets axial spondyloarthritis inflammation on MRI; the uncontrolled two-year data cannot yet show it prevents structural progression better than alternatives.
Many psoriatic arthritis patients cycle through biologics, but few are truly refractory
Before switching yet another biologic in psoriatic arthritis, confirm objective inflammation and assess depression, pain and opioid use.
FDA records a supplement to Celltrion's tocilizumab biosimilar Avtozma
No action needed: this is a routine supplement to a tocilizumab biosimilar licence, not a safety alert or new indication.
Test antiphospholipid antibodies in every patient with lupus
Check lupus anticoagulant, anticardiolipin and anti-β2-glycoprotein I antibodies in every patient with SLE, and confirm positives at 12 weeks.
SLE was associated with more than doubled stroke risk, ischaemic and haemorrhagic
Treat lupus as a stroke risk factor: review blood pressure, lipids, smoking and antiphospholipid status at every annual SLE review.
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