Introduction

The CARE™ Rheumatology Perspectives report provides a Canadian perspective on relevant clinical trials and news in inflammatory arthritis.

Content Foci:
  • Multi disease
  • Rheumatoid Arthritis
  • Psoriatic Arthritis
  • Axial Spondyloarthritis
  • Summary and Parting Comments

We are pleased to have Dr. Philip Baer, CARE™ Rheumatology steering faculty lead, review and provide a Canadian perspective on oral presentations and posters of interest from ACR Convergence 2022.

Faculty involved in this reporting:

Philip Baer, MDCM, FRCPC, FACR, CARE™ Rheumatology steering faculty lead

Summary and Parting Comments

Rheumatoid Arthritis


Efficacy and safety

  • A history of ASCVD is a key risk factor for future MACE events
  • Long-term treatment with Golimumab is a safe treatment option regardless of risk factors.
  • Results from the post-hoc analysis of three Phase 3 UPA clinical trials from the SELECT program: BEYOND, CHOICE, and COMPARE indicated at week 24 ACR 20/50/70 scores comfortably exceeded the commonly cited “Keystone rule” of 50/25/12 in TNF inadequate responders.

New intravenous agents

  • Interesting proof of concept Phase 2a study of peresolimab, a novel intravenous therapy which stimulates the checkpoint Inhibitory receptor PD-1. More data from future studies is awaited.
Psoriatic Arthritis
  • BKZ is a novel dual inhibitor of IL-17 A and F, already approved in Canada for psoriasis and under investigation for psoriatic arthritis. Results of a 52-week active reference arm demonstrate comparable ACR 50 scores vs adalimumab, with higher PASI100 responses. When and where this will be funded for PsA patients in Canada will be of interest.
  • Guselkumab (GUS) is associated with robust and sustained improvement in PsA signs and symptoms in all studied subgroups of patients (pts) pooled from the phase 3 DISCOVER-1 and DISCOVER-2 (D2) trials.
  • Risankizumab (RZB) is efficacious in patients with both limited and extensive joint involvement.
Axial Spondyloarthritis
  • Upadacitinib and two investigational therapies (bimekizumab and filgotinib) may represent new treatment options for nr-axSpA and AS. Filgotinib will not be commercialized in North America, though it is marketed in Europe for other rheumatic diseases.
  • Nr-axSpA may be difficult to confidently diagnose in practice. Careful selection of patients with objective signs of inflammation (high CRP and + MRIs) will enrich the population with those most likely to respond to an advanced therapy such as UPA.
General
  • Canada currently risks falling behind other jurisdictions in the approval and funding of innovative therapies in dermatology and rheumatology, as new agents continue to be developed for multiple indications in these areas.
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