The edition · Rheumatology
The heavier the patient, the smaller the JAK inhibitor response in rheumatoid arthritis
Individual data from 16 phase 3 trials show a stepwise fall in ACR20 response with rising BMI, absent on placebo. Plus myopericardial disease in rheumatic illness against the 2025 ESC guideline, rituximab for refractory lupus nephritis, a relapse calculator for severe ANCA vasculitis, and an FDA tocilizumab biosimilar supplement.
The edition in brief
An individual patient data meta-analysis of 16 phase 3 trials of tofacitinib, baricitinib and upadacitinib (11,883 patients with rheumatoid arthritis) found ACR20 response fell with each BMI band: relative risk 0.94 for overweight, 0.92, 0.88 and 0.78 for obesity classes 1 to 3, with matching rises in DAS28-CRP, and no gradient on placebo, so obesity modified the drug effect. A Lancet Rheumatology review argues the 2025 ESC myocarditis and pericarditis guideline fits patients with systemic autoimmune rheumatic disease poorly, because their cardiac involvement is often subclinical and conventional biomarkers and imaging are less accurate. A meta-analysis of 19 studies (445 patients) found rituximab rescue or add-on therapy for relapsing or refractory lupus nephritis was associated with complete renal response in 41% and overall response in 70% at 12 months, from uncontrolled data. From 649 PEXIVAS participants with severe ANCA vasculitis in remission, a model using sex, induction agent, ANCA type, organ involvement and eGFR predicted two-year relapse with a C-statistic of 0.71, pending validation. The FDA recorded a supplement to Celltrion's tocilizumab biosimilar on 2 September, without stated changes. The pearl covers the cardiac questions to ask in lupus and other connective tissue diseases.
The 2025 ESC myocarditis guideline fits rheumatic disease poorly, a review argues
Generic myocarditis pathways may miss or misread heart involvement in rheumatic disease; assess it jointly with cardiology.
Rituximab rescue for refractory lupus nephritis: about four in ten reached complete renal response
Rituximab rescue for refractory lupus nephritis was associated with complete response in about four in ten patients by a year.
A PEXIVAS-based model estimates two-year relapse risk in severe ANCA vasculitis
A new model gives a two-year relapse estimate in severe ANCA vasculitis; use it to inform monitoring, not yet treatment.
FDA records a supplement to a tocilizumab biosimilar licence
This is an administrative FDA action on a tocilizumab biosimilar; monitoring and prescribing are unchanged.
Ask about the heart at every connective tissue disease review
Ask about cardiac symptoms at every connective tissue disease review, and investigate anything new.
JAK inhibitors worked less well in rheumatoid arthritis as BMI rose
Expect smaller JAK inhibitor responses as BMI rises, and build weight management into rheumatoid arthritis care.
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