Rheum Round-up: Sarilumab Flops in COVID-19, RA TNFi Termination and Body Weight, and more

Here are the top stories recently covered by DocWire News in the rheumatology section. In this edition, read about sarilumab in COVID-19, glucocorticoids in rheumatoid arthritis (RA), body weight and the risk of tumor necrosis factor inhibitor discontinuation in RA, and healthcare utilization predictors of inflammatory arthritis.

Rheumatoid arthritis (RA) drug sarilumab was not an effective treatment for severely ill COVID-19 patients, according to the results of a phase 3 trial. The U.S.-based study was a phase 3 trial comparing 400 mg sarilumab plus best supportive care versus best supportive care alone for COVID-19 patients requiring mechanical ventilation. According to Regeneron, 80% of Kevzara patients and 77% of best supportive care patients in the primary analysis group sustained adverse events (AEs). Serious AEs documented in at least 3% of patients and were more common in the sarilumab group than the best supportive care group included multiorgan dysfunction syndrome (6% vs. 5%) and hypotension (4% vs. 3%). This study has been stopped in the 400 mg group as well as in a higher-dose cohort.

A study compared the effect of low-dose glucocorticoids plus methotrexate and hydroxychloroquine versus placebo plus methotrexate and hydroxychloroquine on symptoms, signs, and inflammation in early RA. After one month of treatment, American College of Rheumatology 20 (ACR20) response was achieved by 55% of the glucocorticoids group and 20% of the placebo group. At month three, 85.0% of the glucocorticoids group and 47.5% of the placebo group achieved ACR20 response; at months six and 12, the rates were 87.5% versus 60.0%, respectively, and 90.0% versus 72.5%, respectively (P<0.05 for all). During the first half of the treatment period, the trial group had significantly lower disease activity score (DAS) 28- erythrocyte sedimentation rate (ESR) scores than the control group. Inflammation, quality of life, and radiological symptoms improved significantly in the glucocorticoids group. Bone erosion did not change in the trial group and worsened in the control group. The correlation coefficient between disease duration and DAS28-ESR score was 0.496 for month one, 0.464 for month three, 0.509 for month six, and 0.550 for month 12. Rates of adverse events did not largely differ between the groups.

RA patients with either a low or high body mass index (BMI) are more likely than normal weight RA patients to discontinue treatment with tumor necrosis factor inhibitors (TNFis), according to a study. Final analysis included 5,230 RA patients. TNFi survival, when compared to that of normal weight patients, was significantly shorter among patients in obesity class II (hazard ratio [HR]=1.28; 95% confidence interval [CI], 1.06 to 1.54), obesity class III (HR=1.67; 95% CI, 1.29 to 2.18), and the underweight group (HR=1.30; 95% CI, 1.07 to 1.58). Among the underweight group, the most significant effect was observed for patients on infliximab (HR=1.82; 95% CI, 1.20 to 2.76). In overweight patients, the most significant effect was noticed for patients taking infliximab (obesity class II: HR=1.49; 95% CI, 0.98 to 2.26; obesity class III: HR=1.46; 95% CI, 0.79 to 2.71) and etanercept (obesity class II: HR=1.27; 95% CI, 0.98 to 1.65; obesity class III: HR=1.79; 95% CI, 1.25 to 2.55).

Patients who eventually go on to be diagnosed with inflammatory arthritis (IA) often present with musculoskeletal symptoms, infections, and comorbidity leading up to their diagnosis, according to a study. During the 1.5-year period before their diagnosis, IA patients were significantly more likely than controls to have health visits for musculoskeletal symptoms—primarily for shoulders, wrists, fingers, and knees—and carpal tunnel syndrome. The odds ratio (OR) was highest at six months prediagnosis (3.2; 95% confidence interval [CI], 2.8 to 3.5), followed by 12 months (OR=2.8; 95% CI, 2.5 to 3.1) and 18 months (OR=2.5; 95% CI, 2.2 to 2.8).