The edition · Rheumatology
Lupus carries about two and a half times the risk of stroke; fracture-prevention evidence in men remains very uncertain
A meta-analysis of 25 cohorts puts stroke risk in SLE at 2.6 times the general population, a Cochrane review finds little reliable fracture data for osteoporosis drugs in men, bimekizumab reduces sacroiliac inflammation and erosion over two years, Nordic registries size difficult-to-manage psoriatic arthritis, and the FDA approves a supplement for the tocilizumab biosimilar Avtozma.
The edition in brief
A meta-analysis of 25 cohort studies (5.2 million people) found SLE was associated with a raised risk of stroke (RR 2.60, 95% CI 2.21 to 3.05), both ischaemic (2.34) and haemorrhagic (2.66), with very high heterogeneity but robust sensitivity analyses. A Cochrane review of 17 trials (4,132 men aged 50 and over) found the effect of bisphosphonates on hip, vertebral and other fractures very uncertain because events were rare and follow-up short; bisphosphonates probably did not increase adverse events. In the BE MOBILE trials, bimekizumab reduced sacroiliac and spinal MRI inflammation at 52 weeks, decreased sacroiliac erosion, and was associated with minimal radiographic progression to 104 weeks in axial spondyloarthritis. In 14,362 Nordic patients starting a biologic for psoriatic arthritis, 36% stopped two or more advanced therapies, but only 2% met a registry-based difficult-to-manage definition and 1.2% were treatment-refractory; women, depression and opioid use were more common in these groups. The FDA approved a supplement to the licence for Avtozma (tocilizumab-anoh, Celltrion) on 2 September; the record does not specify the change. The practical message: treat cardiovascular and thrombotic risk in lupus as actively as the disease itself.
FDA approves a supplement to the Avtozma (tocilizumab-anoh) licence
The FDA approved a supplement to the Avtozma tocilizumab biosimilar licence; check the updated label for what changed.
Cochrane finds fracture benefit of osteoporosis drugs in men very uncertain
Fracture reduction with osteoporosis drugs in men is very uncertain in male-only trials; treat high-risk men on extrapolated evidence and address secondary causes.
Bimekizumab reduced sacroiliac inflammation and erosion with minimal radiographic progression over two years
Bimekizumab reduced sacroiliac and spinal inflammation and erosion in axial spondyloarthritis, with minimal radiographic change over two years.
Over a third of psoriatic arthritis patients stopped two or more biologics, but few were truly refractory
Many psoriatic arthritis patients cycle through biologics, but few have objective refractory inflammation; check for it before switching again.
Five checks before switching a biologic for 'failure'
Confirm objective inflammation and exclude adherence, pain syndromes and depression before switching a biologic.
SLE was associated with about two and a half times the risk of stroke, both ischaemic and haemorrhagic
Treat stroke prevention as part of lupus care: check antiphospholipid antibodies, control blood pressure and lipids, and minimise steroids.
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