It has a productive and enjoyable EULAR in London this year! None of the transport nightmares that we had in Rome last year, pleasant weather and much learning.
My summary of the key learning points in AS are the following:
Secukinumab has arrived. We have a new non-TNF option which is effacious with now 104 week data presented here from the Measure 2 study. Excellent safety profile. Jury is still out on prevention of radiographic progression. Is it better than a TNFi? No head to head trials are available but from indirect comparison of trials presented here, it appears to be as good as a TNFi.
Non-radiographic axial SpA: these patients look similar to AS with the exception of higher percentage of females and less baseline damage with equal burden of disease.The RAPID axSpA trial presented today in the poster session is the first long-term trial of a TNFi (certolizumab pegol) to assess efficacy and safety in a broad AS population, including both AS and nr-axSpA at randomization. Results showed equal efficacy in both groups out to 204 weeks of treatment with similar retention rates and no new safety signals. Radiographic analysis still in progress; maybe ready in time for ACR 2016. I had a chance to speak with the author Dr van der Heijde who pointed out that regardless of radiographic progression, these patients need to be treated due to the similar burden of disease and poor workplace and household productivity that they have.
Smoking is bad for everything now including AS.
EULAR guidelines were presented today to cap off the congress. They are an update from the 2010 guidelines meant to combine EULAR and ASAS recommendations on the management of AS. The key points from the update are the emphasis on both pharmacological and non- pharmacological treatment, continued recommendation of NSAIDs first-line for symptomatic patients with an acceptable risk-benefit profile and more details about TNFi therapy. They are recommended for patients who have failed conventional treatment who have objective signs of inflammation by CRP or imaging. TNF inhibitors are first-line with a second TNFi or IL-17 recommended for TNF failures. Nothing earth shattering but nice to see we are practicing exactly as these guidelines suggest is best practice.
And that's a wrap. Cheerio from London.
Dr. Shelley Dunne is a graduate of Memorial University of Newfoundland School of Medicine. She completed her training in Internal Medicine and a fellowship in Rheumatology at the University of Toronto. She has been in private practice since 1998 and is currently a consulting rheumatologist at the Toronto East General Hospital.View Full Bio