ACR Congress Review 2019

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Effect of tofacitinib on the qualitative HDL profile of RA patients Findings from a study of functional markers of HDL at baseline and 3 months after tofacitinib were presented by Luissi and colleagues. The study enrolled patients diagnosed with RA per <strong>ACR</strong>/EULAR 2010 criteria and who started tofacitinib from January 2016 onwards (bDMARD failures, n=18; cDMARD failures, n=16). At three months of follow up, DAS28 decreased significantly, and TC, C-LDL, HDL-C and C-non-HDL levels increased significantly. No changes were observed in paraoxon activity or phenylacetate activity associated with tofacitinib use in the whole cohort; however, sub-analysis on patients not previously treated with biologic DMARDs showed a significant increase in the activity of these substrates of PON1. The authors concluded that, on bDMARD naïve patients, treatment with tofacitinib improved the antioxidant activity of HDL (paroxonase activity), in spite of an increase in the overall lipoprotein levels [1415]. Impact of switching to tofacitinib Harnett and colleagues presented findings from a retrospective cohort study, assessing the impact of TNFi cycling with adalimumab and etanercept versus switching to tofacitinib. A total of 740 patients with RA who newly started index medication with tofacitinib or select TNFi (adalimumab or etanercept) were identified from a US claims database. Patients who switched from adalimumab or etanercept to tofacitinib had higher persistence, effectiveness, and significantly lower change in RA-related costs compared with patients cycling between adalimumab and etanercept [1426]. Time to discontinue tofacitinib in RA patients Real-world data from a Canadian observational cohort were presented by Movahedi and colleagues. The authors examined the discontinuation rate of tofacitinib, with and without concurrent MTX, and with and without prior biologic use. Among the 131 patients included in the analysis, 53.4% received tofacitinib without MTX and 46.6% received tofacitinib with MTX. Discontinuation was reported in 33.6% of all tofacitinib patients with a median survival of 31.3 months and overall retention at 6, 12 and 24 months was 80.5%, 63.1% and 53.5% respectively. Thirty-four percent of patients stopped their tofacitinib due to non-response/loss of response, 50.0% due to adverse events, and 16% due to other reasons. Discontinuation due to any reason was borderline significantly lower in the tofacitinib plus MTX group compared with the tofacitinib without MTX group. There was no significant difference in tofacitinib discontinuation between the two groups of patients with and without prior biologic use (P=0.77) [1428]. Impact of time since first diagnosis on tofacitinib safety and efficacy in PsA Nash and colleagues presented a secondary analysis of the Phase 3 OPAL Broaden study to examine the efficacy and safety of tofacitinib in patients with PsA, stratified by time since first PsA diagnosis. OPAL Broaden was a 12-month study in which csDMARD-IR patients with active PsA were randomised to receive tofacitinib 5 or 10 mg BID or placebo. A total of 316 patients were included in the analysis (
Impact of BMI on tofacitinib safety and efficacy in PsA A post-hoc analysis on the impact of baseline BMI on tofacitinib efficacy and safety in patients with PsA was presented by Ritchlin and colleagues. Data were pooled from two placebo-controlled, double-blind, Phase 3 studies in patients with active PsA and an inadequate response to ≥1 csDMARD (OPAL Broaden) or to ≥1 TNFi (OPAL Beyond). The analysis included 710 patients of whom 43.8% were obese (BMI ≥ 30). At baseline, 161 patients had a BMI
Page 1 and 2: Enhancing knowledge of the clinical
Page 3 and 4: Highlights from ACR 2019 During the
Page 5 and 6: In summary, individually, high base
Page 7 and 8: treatment with MTX. A total of 1629
Page 9 and 10: Individual and composite measures o
Page 11 and 12: Upadacitinib in axial spondylarthri
Page 13: Safety, efficacy and PROs with a to
Page 17 and 18: Patient-reported outcomes with JAK
Page 19 and 20: Update on JAK inhibitor safety data
Page 21 and 22: In the first presentation, the anal
Page 23 and 24: References Bergman M, Tanaka Y, Cit
Page 25 and 26: Kremer J, Van den Bosch F, Rubbert-

ACR Congress Review 2019

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