Rheum Round-up: Rinvoq vs. Competitors, Patients ‘Worse than death’ Before Arthroplasty, and More

Here are the top stories covered by DocWire News this week in the Rheumatology section. In this edition, read how Rinvoq stacks up to its competitors, patients who describe their state as “worse than death” before joint arthroplasty, the effect of corticosteroid injections on plantar heel pain, and the safety and efficacy of adalimumab in children.

AbbVie has announced that the Food and Drug Administration (FDA) approved its rheumatoid arthritis (RA) drug Rinvoq (upadacitinib). Rinvoq is an oral Janus kinase (JAK) inhibitor designed for the treatment of moderate to severe RA in patients who did not respond or have an intolerance to methotrexate. The company reported that the JAK inhibitor will be available in the United States in late August. Rinvoq will be sold for $59,000 a year in the U.S. Humira, also manufactured by AbbVie and indicated in the treatment of RA, costs an estimated $5,174 for a four-week supply, coming in at an annual cost of over $60,000. Rinvoq will compete with fellow JAK inhibitors Olumiant and Xeljans, manufactured by Eli Lilly and Pfizer, respectively. According to Eli Lilly, the list price for Olumiant is $2,136.90 for a 30-day supply, totaling about $25,642.80 annually. Xeljans has an estimated cost of $4,686 for a supply of 60 5-mg tablets (a recommended dose is two 5-mg tablets daily), with the annual cost coming to roughly $56,232.

Nearly one in five patients waiting to undergo total hip arthroplasty (THA) described their state ahead of the procedure as “worse than death (WTD),” according to a new cross-sectional analysis. A smaller percentage awaiting total knee arthroplasty (TKA) also reported pain WTD. In total, 391 THA patients (19%) and 263 TKA patients (12%) were WTD prior to surgery. In THA patients, factors associated with WTD included preoperative Oxford Hip Score (OHS), deprivation, and chronic obstructive pulmonary disease, and in TKA, factors included Oxford Knee Score (OKS), peripheral arterial disease, and inflammatory arthropathy (P < 0.05). Among both cohorts, EuroQol five-dimension scores significantly improved one year after surgery; WTD rates in THA and TKA patients fell to 35 (2%) and 53 (3%), respectively. Preoperative WTD had significantly poorer one-year OHS and OKS and satisfaction rates compared to patients who were not WTD before surgery.

A review of randomized trials compared corticosteroid injection to other treatment strategies for plantar heel pain and found that while it outperforms “some comparators,” it “is not more effective than placebo injection for reducing pain or improving function.” Final analysis included 47 trials encompassing 2,989 patients. In improving short-term pain outcomes, corticosteroid injection was more effective than autologous blood injection and foot orthoses . No substantial evidence was found on medium-term outcomes. Corticosteroid injection was not as effective in the long-term as dry needling or platelet-rich plasma injection. When comparing corticosteroid injection to placebo injection, there were no significant differences in pain reduction in the short and medium terms. In the short-term, corticosteroid injection more effectively improved function than physical therapy. “When trials considered to have high risk of bias were excluded, there were no significant findings,” the researchers noted.

A new study testing the safety and efficacy of adalimumab for polyarticular‐course juvenile idiopathic arthritis found that the medication is well-tolerated in younger patients. Final analysis included 838 patients: 301 methotrexate alone and 537 adalimumab plus methotrexate patients. In the methotrexate arm, the most common adverse events (AEs) were nausea (10.3%), sinusitis (4.7%), and vomiting (4.3%). In the adalimumab plus methotrexate arm, the most common AEs were arthritis (3.9%); upper respiratory tract infection (3.5%); and sinusitis, tonsillitis, and injection site pain (3.0% each). Serious infection rates were 1.5 events/100 person years and 2.0 events/100 person years in the methotrexate alone and adalimumab plus methotrexate groups, respectively. Rates of AEs and serious AEs were similar between the groups, and there were no reports of deaths or malignancies. New users in the adalimumab plus methotrexate cohort had lower mean JADAS27CRPcompared to the new methotrexate users in the first year of the study.