Highlights and Low Lights from EULAR 2017

Our highlights and low lights from EULAR 2017:

• Vobarilizumab is a nanobody that inhibits IL-6, but it failed in MTX-IR RA trials (there were regional differences with respect to placebo response that may or may not have affected the outcome of the study). (Dorner T et al, OP098)

• Ongoing safety monitoring for risk of infections with JAK-inhibitors (baricitinib meta-analysis of phase III trial results) adds to the body of evidence for tofacitinib and TNFi and non-TNFi biologics – all have similar rates of serious infection. (Strand V et al, THU0211)

• Doesn't matter (in RA) what target you use, just use it to get more patients into remission/low disease state. Favorite targets are CDAI, SDAI, DAS28, RAPID3, Boolean remission, ultrasound remission, etc. (numerous abstracts)

• All ANCAs are not created equal – they have post-translational modifications that may be important for prognosis, flaring, etc. (Luqmani R et al, SP0132)

• Certolizumab pegol does not cross the placenta and should be safe in women needing treatment while pregnant. (Mariette X et al, OP0017)

• IL-18 is in the IL-1 family. Tadekinig alfa is a recombinant IL-18 protein binding inhibitor that seemed to help patients with adult onset Still's disease who were recalcitrant to previous treatment, in an open-label phase II trial. (Gabay C et al, FRI0582).

• In giant cell arteritis, MTX can prevent relapses compared to patients not on MTX (D Frietes et al, THU0309) and the dose of tocilizumab in GCA is likely more optimal at 162 mg SC weekly. (Sone J et al, OP0131)

• Lots of early and later phase drug trials in SLE evaluating various mechanisms (atacicept [BLyS and APRIL with B cell signalling changes], drugs affecting plasma cells, CC2, ICOS, gamma interferon reduction, calcineurin inhibitor the latter in SLE nephritis had more deaths when added to MMF than MMF alone). I assume there is more to come.

• Stop studying IL-1 inhibition in OA, the studies have all failed as did another one presented at EULAR.

• Retention and response (EULAR good response) are better when non-TNFi biologics are used as the first biologic in RA than TNFi biologics. (Swedish register). (Frisell T, FRI0213)

• Oral strategy study (Fleischmann R et al. Lancet 2017) in MTX-IR showed that adding either tofacitinib or adalimumab were not inferior to each other, but stopping MTX and switching to tofacitinib has inconclusive results (not non-inferior but can't say inferior, but numerically is a bit less).

• Rituximab with belimumab helped severe refractory SLE in an open-label trial. (Krasji T et al, SAT0258, OP0302)

• Cyclophoshamide did not prolong survival in follow-up of a scleroderma lung study. (Volkmann ER et al, OP0124)

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