CARE™ Reports

CARE™ Perspectives Report: EULAR 2021

Rheumatology

05 Aug 2021

Introduction
The annual EULAR conference updates scientific developments in rheumatology.

This report will focus on:
  • Impact of novel agents on approaches to treating inflammatory arthritis.
  • Parting comments consider:
    • Challenges related to medication funding in Canada.
    • Considerations (and limitations) regarding improving current options through better treatment sequencing, combination therapies, head-to-head comparative efficacy trials, and/or earlier identification of key clinical features and biomarkers that are suggestive of treatment failure.
  • CARE™ Faculty request our readers to participate in an inflammatory arthritis needs assessment.

We are pleased to have CARE™ Rheumatology steering faculty lead Dr. Philip Baer provide a Canadian perspective on EULAR 2021 abstract and presentation content.

Parting Comments (Key Takeaways)

Access to innovation is needed:

  • Approval of innovative agents with different modes of action (MOA) is needed. While multiple agents targeting TNF have been approved in Canada, fewer choices that target IL-6, JAK inhibition, IL-17 and IL-23 are available to rheumatology
    clinicians.
  • Significant news was released on PsA at this year’s EULAR, specifically on JAKi and IL-23 inhibitors, but gaps in treatment and questions about funding for innovative therapies persist.

Currently available oral treatments for PsA have an efficacy that is generally lower than TNFi’s, or may require combination with methotrexate or other csDMARDs for optimal efficacy.

  • Upadacitinib as an oral therapy in PsA is considered a significant advance.

There are concerns regarding timely access to innovative new therapies in Canada:

  • Promising new therapies will soon be available for PsA, but how and when new agents will be funded in Canada remains an area of speculation.

The plethora of options with current and novel therapeutic molecules present a challenge.

  • Trials for specific disease domains are needed to identify better clinical efficacy.
    • Example: PsA and axial disease, where IL-17 inhibitors are contraindicated in patients with active IBD, and IL-23 inhibitors are not approved for axial SpA.
    • New onset and exacerbation of IBD have been reported in clinical studies with secukinumab and ixekizumab.
    • New GRAPPA recommendations on PsA management were released at EULAR 2021.

Risk factors for adverse events may differ between older and younger patients and are not fully understood. E.g., ORAL Surveillance study, and abstract OP0116.

The data presented on safety and efficacy of COVID-19 vaccines in patients with rheumatic and musculoskeletal disease are reassuring.

  • Our understanding of COVID-19 and its impact on management of RA and other rheumatological diseases continues to evolve.
Abstracts Covered in Report
Psoriatic Arthritis (PsA)

 

LB0004. Efficacy and Safety of Secukinumab in Enthesitisrelated Arthritis and Juvenile Psoriatic Arthritis: Primary Results from a Randomised, Double-blind, Placebo-controlled, Treatment Withdrawal, Phase 3 Study (JUNIPERA).
N. Ruperto et al.

  • In children and adolescents with ERA and JPsA, efficacy of SEC was demonstrated with a significantly longer time to flare vs PBO with sustained improvement of signs and symptoms up to Wk 104 and a favourable safety profile.

OP0233. Efficacy and Safety of Upadacitinib in Patients With Psoriatic Arthritis and Axial Involvement.
A. Deodhar et al.

CARE™ Canadian Perspective:
Axial involvement in PsA is frequent, often poorly defined in trials, different from ankylosing spondylitis, and a key treatment domain. This study is the first

OP0230. Efficacy and Safety of Guselkumab in Patients with Active Psoriatic Arthritis Who Demonstrated Inadequate Response to Tumor Necrosis Factor Inhibition: Week 24 Results of a Phase 3b, Randomized, Controlled Study.
L. C. Coates et al.

CARE™ Canadian Perspective:
IL-23 inhibitors such as GUS are approved in psoriasis and now in psoriatic arthritis. This study showed efficacy of GUS even in a TNF-refractory PsA population, providing another class of agents effective in this cohort of patients.

POS1027. Efficacy and Safety of Guselkumab, a Monoclonal Antibody Specific to the p19-Subunit of Interleukin-23, Through Two Years: Results from a Phase 3, Randomized, Doubleblind, Placebo-controlled Study Conducted in Biologic-naïve Patients with Active Psoriatic Arthritis.
I. Mcinnes et al.

CARE™ Canadian Perspective:
Long-term efficacy of GUS in PsA with a satisfactory safety profile was demonstrated in this biologic-naïve population, both for joint and skin outcomes, with retention of close to 90% of patients at the 2 year timepoint.

OP0229. The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) Treatment Recommendations 2021.
L. C. Coates et al.

CARE™ Canadian Perspective:
These new GRAPPA algorithms represent the most current PsA treatment recommendations, with specific guidance provided for managing all domains of psoriatic disease.

Rheumatoid Arthritis (RA)

 

OP0116. Elderly patients are not at increased risk of serious
infections when receiving bDMARDs or JAK inhibitors
compared to csDMARD treatment.
A. Strangfeld et al.

CARE™ Canadian Perspective:
Active inflammation, steroid use and comorbidities are associated with increased risk of serious infections in RA patients. With regard to infection risk, both JAKi and bDMARDs are reasonable choices in older RA patients.

OP0122. Comparative effectiveness of JAKi versus bDMARDs;
a nationwide study in RA.
A. Barbulescu et al.

CARE™ Canadian Perspective:
Real-world effectiveness of JAKi and bDMARDs was statistically similar in this analysis of Swedish RA patients.

OP0128. Integrated laboratory abnormality profiles of
upadacitinib with up to 4.5 years of exposure in patients with
rheumatoid arthritis treated in the SELECT phase 3 program.
C. Charles-Schoeman et al.

  • The long-term analysis of UPA-treated pts with RA showed dose-dependent relationships for several laboratory abnormalities.

POS0653. Impact of Upadacitinib or Adalimumab as Initial
Therapy on the Achievement of 48-Week Treatment Goals in
Patients with Rheumatoid Arthritis and Inadequate Response
to Methotrexate: Post hoc Analysis of a Phase 3 Study.
E. Mysler et al.

CARE™ Canadian Perspective:
SELECT-COMPARE design included blinded direct switching as rescue therapy from UPA to ADA and vice versa. Patients benefited from either switch, but efficacy outcomes favoured the initial UPA group.

COVID-19

 

LB0002. COVID-19 vaccine safety in patients with rheumatic and musculoskeletal disease.
P. M. Machado et al.

LB0003. Immunogenicity and safety of the BNT162b2 mRNA Covid-19 vaccine in adult patients with autoimmune inflammatory rheumatic diseases and general population: a multicenter study.
V. Furer et al.

CARE™ Canadian Perspective:
Most DMARDs can be continued when administering the Pfizer BNT162b2 mRNA COVID-19 vaccine. This study (LB0002) confirms concerns about the efficacy of the vaccine in patients treated with rituximab. In addition, clinical data presented at the EULAR 2021 meeting confirm a high risk of complications from COVID-19 in patients treated with rituximab. We must encourage our patients to get vaccinated.

Additional Resources
CARE Congress Rheumatology Perspective
CARE Rheumatology Update