The edition · Rheumatology
Starting early RA on a biologic or JAK inhibitor plus methotrexate raises 6-month remission by about 60%
A meta-analysis of 29 trials quantifies the gain from first-line advanced therapy against methotrexate alone; avacopan is linked to fewer severe infections in ANCA vasculitis; and axial SpA diagnosed within two years shows less spinal damage a decade on.
The edition in brief
Four items for rheumatologists. A meta-analysis of 29 randomised trials (13,387 methotrexate-naive adults with early rheumatoid arthritis) found starting a biologic or targeted synthetic DMARD with methotrexate increased DAS28 remission at 6 months compared with methotrexate alone (RR 1.62, 1.39 to 1.89), with larger benefit in high disease activity and rheumatoid factor-positive populations; as monotherapy, only tocilizumab and JAK inhibitors beat methotrexate. In a multicentre cohort of 387 patients with ANCA-associated vasculitis, avacopan exposure was associated with fewer severe infections (adjusted HR 0.22, 0.07 to 0.68) and less prednisolone, with no clear difference in relapse. In a Swiss registry of 376 patients followed a mean 11.5 years, axial spondyloarthritis diagnosed within two years of symptom onset had less radiographic spinal damage (−3.85 mSASSS units), a gap emerging 10 to 15 years after diagnosis. The FDA recorded a supplement to Pfizer's abrocitinib (Cibinqo) licence. The pearl covers not letting cost decide the first-line conversation.
Avacopan linked to fewer severe infections in ANCA-associated vasculitis
Avacopan-based, steroid-sparing induction was associated with fewer severe infections in ANCA vasculitis.
Axial spondyloarthritis diagnosed early shows less spinal damage 10 to 15 years later
Diagnosing axial spondyloarthritis within two years of symptoms is associated with less spinal damage a decade later.
FDA records a supplement to Pfizer's abrocitinib licence
No change for rheumatology practice; check for JAK inhibitors prescribed elsewhere.
Stratify early RA before deciding on first-line therapy
Record disease activity and serology at diagnosis so first-line escalation decisions can be targeted.
First-line biologic or JAK inhibitor plus methotrexate: more remission in early RA
In early RA with poor-prognosis features, consider starting a biologic or JAK inhibitor alongside methotrexate rather than methotrexate alone.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this one is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for rheumatology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free