JAK inhibitors worked less well with every step up in BMI

The edition in brief

An individual patient data meta-analysis of 16 phase 3 trials (11,883 patients with rheumatoid arthritis) found JAK inhibitor response fell with rising BMI. Compared with healthy weight, the relative risk of ACR20 response was 0.94 with overweight, 0.92 with class 1 obesity, 0.88 with class 2 and 0.78 with class 3, with a matching DAS28-CRP gradient; no such gradient appeared on placebo, so obesity modified the drug effect. In a US rheumatology registry of 238 patients with ANCA-associated vasculitis on avacopan, liver enzyme elevations were uncommon, but two cases (0.8%) of drug-induced liver injury were judged highly probable, one with severe hepatocellular injury on biopsy; the paper reports that FDA had requested market withdrawal, which the manufacturer declined. In 2,222 patients with early RA in a Canadian cohort, those given parenteral glucocorticoids in the first three months were about half as likely as those on oral steroids to still be taking them at a year (26% vs 47%), with similar escalation to advanced therapy. FDA recorded a supplement on 28 August to the licence for Yusimry (adalimumab-aqvh), a biosimilar; the record gives no detail and signals no safety change.