ACR 2019 – Annual meeting in Atlanta, Georgia
Another year goes by, and another ACR annual meeting. This year’s meeting presented lots of information. I thank ORADE and the ORA for the opportunity to travel to ACR this year. Here are some of the highlights from the conference.
In the world of psoriatic arthritis, data was presented showing favourable PASI scores for newer drugs such as guselkumab (targeting p19 subunit – IL 23 inhibitor) and risankizumab vs adalimumab. No new safety signals were found (Lancet 394 Aug 2019, 576-586). SPIRIT-Head to Head study showed good data for Ixekizumab vs adalamumab in biological naïve patients at 24 wks. One key concept presented was for 1st line biologic use – for improved joint as well as skin outcomes.
In RA news, filgotinib (JAK 1 inhibitor) vs placebo in moderate-severe RA for patients intolerant /inadequately responding to biologic DMARDs showed promise for this new agent. Also data for use of upadacitinib (JAK 1 inh) as monotherapy showed ACR 20 scores maintained without background MTX to 24 wks (Lancet 2019 393: 233), and rapid onset of improvement within wks.
In osteoporosis news, data was presented showing denosumab > risedronate for glucocorticoid induced osteoporosis at 24 months in regards to BMD but no change in fractures or AEs (Arth and Rheum July 2019 vol 71 (7), 1174-84. Data from the Womens health initiative (involving > 77 000 women) showed that even mild activity like walking can lower hip fracture risk. The great debate this year discussed the use of anabolic agents as appropriate 1st line therapy for glucocorticoid-induced osteoporosis. Dr K Saag weighed in on the pro side, suggesting better biologic rationale, BMD data with studies comparing teriparitide vs bisphosphonates. On the con side was Dr M Humphrey, pointing out that although teriperitide has better data vs bisphosphonates for prevention of vertebral fracture and hips fracture, there is lack of data for prevention of wrist fractures. Also data suggests that teriperitide is less effective at preventing fractures with high (>15 mg/d) use of prednisone. Costs were a big con issue.
The FDA had approved nintedanib (TK inhibitor) for systemic sclerosis associated interstitial lung disease. Apremilast has FDA approval for behcets syndrome, showing a 52.9 % ulcer response rate, better than placebo. FDA issued black box warning for febuxostat fr CV death. FDA approved a liquid form of colchicine.
2 year extension study data looks good for tocilizumab in giant cell arteritis.
In OA news, data were discussed regarding metformin associated with lower progression of knee OA. An interesting talk by Dr C Evans on gene therapy and OA explored the idea of using an adeno-associated virus as a vector to transport gene/RNA to cells, with potential therapeutic applications for OA. A plenary session talk by Dr C Roux discussed methotrexate 10 mg/w vs placebo in patients with hand erosive OA for 1 year – but found MTX to be not superior to placebo. However, other data suggested use of low dose prednisolone 10 mg od for 6 wks vs placebo did lead to an improvement of symptoms.
New EULAR-ACR 2019 criteria for SLE involves a requirement for ANA 1: 80 or greater, and the weighted criteria showed sensitivity of 96.1% and specificity of 93.4%.
Overall lots of interesting data were presented, and the coming years promise more therapies for much of our field.