Rheum Round-up: RA Drug Comparisons, Diabetes Meds and Fracture Risk, and More

Here are the top stories covered by DocWire News this week in the Rheumatology section. In this edition, learn about the efficacy of baricitinib monotherapy versus in combination with methotrexate, which diabetes medications may increase fracture risk, and more.

A recent study published in Arthritis Care & Research assessed the long-term efficacy and safety of baricitinib in patients with active rheumatoid arthritis (RA) whose initial treatment was baricitinib monotherapy or who switched from methotrexate or the combination of baricitinib plus methotrexate to baricitinib monotherapy. The study, RA-BEYOND, was a follow-up to a 2017 study, RA-BEGIN. The present study included patients from RA-BEGIN who were not rescued in the first study. At week 52 of RA-BEGIN, patients entering the extension were treated with baricitinib 4 mg/day monotherapy and could receive methotrexate if deemed appropriate. The study authors concluded by saying that most active RA patients achieved sustained or improved disease control through continued baricitinib monotherapy or with the addition of methotrexate, noting that among patients who initially demonstrated poorer disease control, add-on methotrexate was helpful.

Insulin, thiazolidinedione, and sulphonylureas may be associated with a greater risk of fracture, a new study has found. The researchers queried PubMed and Web of Science databases for relevant observational studies from inception through February and found 33 studies relevant studies, of which 26 were cohort and seven were case-control studies. An estimated 345,133 fractures were reported in about 6,847,158 patients. Studies reported on the use of metformin (n = 12), insulin (n = 23), sulphonylureas (n = 10), and thiazolidinediones (n = 14). Fracture risk was increased among patients using insulin (relative risk [RR] 1.49, 95% confidence interval [CI] 1.29-1.73), sulphonylureas (RR 1.30, 95% CI 1.18-1.43), and thiazolidinediones (RR 1.24, 95% CI 1.13-1.35), while fracture risk was decreased among patients using metformin (RR 0.86, 95% CI 0.75-0.99). When assessing fracture risk associated with different types of thiazolidinediones, RRs were similar between pioglitazone (1.38, 95% CI 1.23-1.54) and rosiglitazone (1.34, 95% CI 1.14-1.58) use.

In Case You Missed It: Patients with active RA with inadequate response to conventional synthetic (cs) or biologic (b) disease-modifying antirheumatic drugs (DMARDs) may have better outcomes with upadacitinib compared to tofacitinib, according to new research. The analysis included nine randomized controlled trials encompassing a total of 5,794 RA patients. Upadacitinib 15 mg plus methotrexate and upadacitinib 30 mg plus methotrexate were considered the most effective treatment modalities, followed by tofacitinib 10 mg plus methotrexate, tofacitinib 5 mg plus methotrexate, and adalimumab plus methotrexate. Serious adverse event rates were not significantly different among upadacitinib plus methotrexate, tofacitinib plus methotrexate, adalimumab plus methotrexate, and placebo plus methotrexate treatments.

In Case You Missed It: Triclosan, a chemical typically seen in soaps and hand sanitizers, may increase the risk of osteoporosis in women, particularly postmenopausal women, according to new research. The researchers assessed data from the 2005–2010 National Health and Nutrition Examination Survey to evaluate an association between urinary concentrations of triclosan and bone mineral density (BMD) and osteoporosis in women aged ≥ 20 years. The final analysis included 1,848 women. Adjusted analyses revealed “significant associations between tertile 3 of TCS concentration and lower BMD in regions of total femur (β=-0.016, 95% CI=-0.032, -0.000), intertrochanter (β=-0.022, 95% CI=-0.042, -0.002), and lumbar spine (β=-0.014, 95% CI=-0.029, 0.001), respectively, relative to tertile 1,” the authors observed. Women in tertile 3 had a greater risk of osteoporosis in intertrochanter (odds ratio = 2.464, 95% CI = 1.190, 5.105).