Rheum in Review: Arthritic Women and Pregnancy, Yoga for Arthritis, Biosimilar Approval, and More

Here are the top stories covered by DocWire News this week in the Rheumatology section. In this edition, learn how an arthritis diagnosis affects a woman’s decision to have children, the possible benefits of yoga and tai chi for arthritis, what psoriatic arthritis patients should do when stopping a tumor necrosis factor inhibitor, and about the latest etanercept biosimilar approval.

For many women, an arthritis diagnosis goes beyond joint pain and inflammation, according to the findings of a recent survey. The researchers evaluated responses from 267 women (mean age, 39.6 years; mean age at diagnosis, 27.2 years) with inflammatory arthritis, of whom 58% (n = 149) said their arthritis impacted their decision to have children. The top three reported concerns were that they would be unable to care for the child (n = 126, 85%), that antirheumatic drugs would harm the baby (n = 91, 61%) and that the child might inherit arthritis (n = 77, 52%). Meanwhile, 37% (n = 96) said that their diagnosis did not change their decision. Most of these women (n = 49, 51%) said they had children before they were diagnosed; the rest said arthritis did not affect their decision (n = 31, 32%), they never wanted children (n = 9, 9%), or they plan to adopt or have adopted (n = 8, 8%). The remaining 12 respondents (5%) said they had not yet thought about having children.

Namaste! Could yoga be of any benefit to arthritis patients? What about tai chi? As the idea of alternative medicine gains more traction across the nation, patients may have questions about how these activities and others like it could perhaps benefit their condition. While the evidence is not as robust for alternative options as for traditional medications, some preliminary research suggests that some patients may have positive outcomes. Arthritis patients who practiced yoga reported a better relationship with their pain, reduced depression symptoms, flexibility, and health-related quality of life outcomes. Similarly, the benefits associated with tai chi were both mental and physical. The common take-home message in many of the studies, though, is that the jury is still out. Long-term, randomized, controlled trials are needed to definitively say whether yoga, tai chi, and other similar strategies do in fact help rheumatic diseases.

For psoriatic arthritis (PsA) patients taking a tumor necrosis factor inhibitor (TNFi) who are looking to switch their medication, their best option may be to switch to a different TNFi as opposed to a non-TNFi. Researchers evaluated 2,107 PsA patients who were switching from a TNFi to a different one, and 253 patients on a TNFi switching to a non-TNFi. The new TNFi group reported fewer dermatologist visits, but more rheumatologist visits, than the non-TNFi group. The TNFi patients also had significantly lower total average healthcare expenditures (adjusted difference: $17,625), which the researchers said could be attributed to lower prescription drug (adjusted difference: $17,172) and hospitalization expenditures (adjusted difference: $5,772). New TNFi patients were also more likely to continue with their new treatment compared to those switching to a non-TNFi (median time to discontinuation: 8.31 vs. 5.68 months).

The Food and Drug Administration has approved ETICOVO (etanercept-ykro). Manufactured by Samsung Bioepis, ETICOVO is a second biosimilar for etanercept (ENBREL, Amgen) and is indicated to treat rheumatoid arthritis (RA) polyarticular juvenile idiopathic arthritis in patients aged ≥ 2 years, PsA, ankylosing spondylitis, and plaque psoriasis in patients aged ≥ 4 years. Its efficacy was measured in a trial with RA patients for whom treatment with methotrexate (MTX) was unsuccessful, comparing ETICOVO to etanercept. The trial initially included 596 patients (mean age, 51.8 years), of whom 299 received ETICOVO and 297 received etanercept. The majority of the cohort was younger than 65 years old, and the mean disease duration was 6.1 years. Patients had a mean MTX duration use of 47.7 months. A total of 505 patients completed the trial. The study’s primary outcome—the proportion of patients who achieved at least 20% ACR response criteria improvement—was achieved, and other outcomes—28-joint Disease Activity Score, Simplified and Clinical Disease Activity Indices, and changes in the modified total Sharp score—had similar between-group outcomes as well. The study also found similar safety profiles between the groups.