Rheum Round-up: Latest Baricitinib Research, Autoimmune Diseases and COVID-19, and more

Here are the top stories recently covered by DocWire News in the rheumatology section. In this edition, read about the latest studies on Eli Lilly’s arthritis drug baricitinib, whether autoimmune diseases impact COVID-19 outcomes, the “unwritten rules” of being a woman surgeon, and a comparison of abatacept versus upadacitinib.

Eli Lilly’s rheumatoid arthritis (RA) drug baricitinib, marketed as Olumiant, has been the subject of several clinical trials in the fight to treat COVID-19. A recent study observed that, when combined with corticosteroids—compared to corticosteroids alone—the drug associated with improved pulmonary function in patients with COVID-19 pneumonia. As COVID-19 data continue to be published, though, non-COVID-19 studies are also ongoing. Click here to read highlights on several studies reporting the non-COVID-19 impacts of baricitinib.

Patients with autoimmune diseases may be at a greater risk for COVID-19, possibly due to glucocorticoid use, while certain antirheumatic drugs may lower the risk of severe disease, according to a study. Among 62 observational studies with 319,025 total patients with autoimmune diseases, the COVID-19 prevalence was 0.011. A meta-analysis of seven case-controlled studies observed a significantly increased risk for COVID-19 in patients with autoimmune diseases than controls. A meta-regression analysis yielded a significant correlation between glucocorticoids and COVID-19 risk. A clinical outcomes assessment was performed with data from 65 studies encompassing 2,766 patients with autoimmune diseases diagnosed with COVID-19. The hospitalization rate was 0.35, and the mortality rate was 0.066. Glucocorticoids, conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), and biologic or targeted synthetic DMARDs (b/tsDMARDs–csDMARDs combination therapy all appeared to elevate the risk for both hospitalization and mortality.

A study that put RA drugs upadacitinib and abatacept head-to-head yielded mixed results: upadacitinib was associated with better disease outcomes, but at the cost of more serious adverse events (AEs). At baseline, Disease Activity Score for 28 joints based on the C-reactive protein level values were 5.70 in the upadacitinib group and 5.88 in the abatacept group; at week 12, the mean changes were −2.52 and −2.00, respectively. A significantly greater proportion of patients in the upadacitinib group achieved remission compared to the abatacept group (30.0% vs. 13.3%; difference, 16.8 percentage points. Serious AEs in the upadacitinib group during treatment included death (n=1), nonfatal stroke (n=1), and venous thromboembolic events (n=2). The upadacitinib group had a greater proportion of patients with elevated hepatic aminotransferase levels compared to the abatacept group.

Despite efforts to increase gender diversity in medicine, women remain widely underrepresented in the field—notably in surgery, be it general surgery, where women comprise less than 21% of the field, or in subspecialties, such as orthopedics, where they only make up 5.3% of the field. Recently, women surgeons were interviewed about their experiences with interprofessional conflict. The researchers questioned how this may affect personal, professional, and patient outcomes, as well as potential ways to navigate such conflict. The surgeons discussed the following ways of navigating conflict: relationship management, rapport building, and building social capital. According to the researchers, their responses “could be collectively considered the unwritten rules of being a woman surgeon.”