Rheum Round-up: Hydroxychloroquine Still A Flop for COVID-19, Real-World RA Treatment Comparison, and more

Here are the top stories recently covered by DocWire News in the Rheumatology section. In this edition, read about more research rejecting hydroxychloroquine as a COVID-19 treatment, real-world outcomes between rheumatoid arthritis patients treated with triple therapy versus tumor necrosis factor inhibitor plus methotrexate, new guidelines for gout management, and the efficacy of intra-articular hypertonic dextrose prolotherapy versus normal saline injection for osteoarthritis of the knee.

Hydroxychloroquine, a drug prescribed to treat rheumatoid arthritis (RA) and lupus, has been touted as a possible treatment for COVID-19, leading to an influx of studies on the subject as well as nationwide shortages of the drug. However, another study has come out rejecting the notion that hydroxychloroquine is a useful drug for COVID-19, with the authors concluding that “treatment with hydroxychloroquine, azithromycin, or both, compared with neither treatment, was not significantly associated with differences in in-hospital mortality.”

A recent study compared real-world outcomes between RA patients treated with triple therapy versus tumor necrosis factor inhibitor plus methotrexate (TNF/MTX). The researchers concluded that Triple therapy is not nearly as common as TNF/MTX and may not be as clinically effective. Triple patients, compared to TNF/MTX patients, were more likely to discontinue therapy in both the biologic-naïve and biologic-experienced groups. After six months, in the biologic-naïve group, TNF/MTX patients had a significantly greater proportion of patients attain low disease activity compared to the Triple group ; biologic-naïve TNF/MTX patients also had a significantly greater mean change in Clinical Disease Activity Index. Similar results were observed in the biologic-experienced cohort, but the difference was not as significant.

The American College of Rheumatology (ACR) recently released updated guidelines for managing gout. As the most prevalent inflammatory arthritis, gout afflicts about 9.2 million U.S. adults; still, quality of care gaps remain. Previous guidelines—including the 2012 ACR Guidelines for the Management of Gout—suggest that treat-to-target strategies with urate-lowering therapy (ULT) be used. However, ULT utilization has not increased in two decades, and adherence is still poor—in fact, it’s the lowest adherence among treatments for seven chronic conditions. Improving adherence has been difficult in part because the ACR’s guidelines from 2012 had low-quality evidence for its treat-to-target recommendations.

A new study compared the efficacy of intra-articular hypertonic dextrose prolotherapy (DPT) versus normal saline injection for osteoarthritis (OA) of the knee. The present trial took place at a university primary care clinic in Hong Kong and randomized 76 knee OA patients 1:1 to DPT or normal saline for injections at weeks zero, four, eight, and 16. The main outcome was the Western Ontario McMaster University Osteoarthritis Index (WOMAC) pain score. At 52 weeks, the WOMAC pain score had an estimated –10.34-point difference-in-difference (95% confidence interval [CI], –19.20 to –1.49; P=0.022).