Rheum Round-up: Upadacitinib vs. Tofacitinib, Hand Sanitizer and Osteoporosis, Glucocorticoid Tapering Effects, and More

Here are the top stories covered by DocWire News this week in the Rheumatology section. In this edition, read about upadacitinib versus tofacitinib for treating active rheumatoid arthritis (RA), the link between hand sanitizer and osteoporosis, continuous glucocorticoid (GC) treatment versus tapering therapy, and the prevalence of chronic pain among cancer survivors.

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.

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).

In a recent study, researchers compared outcomes associated with continuous GC treatment in RA patients as opposed to tapering therapy. They found that continued GC treatment was associated with better disease control. Patients were randomized to 24 weeks of blinded GC 5 mg or to undergo blinded taper (GC taper, from 4 mg/d with 1-mg reduction every four weeks to 0 mg/d at weeks 16-24) while continuing stable tocilizumab and csDMARD doses. Results for the primary outcome favored the continued treatment group. “The primary endpoint of mean change in disease activity score based on 28 joint counts (DAS28) was larger with prednisone taper than with continued prednisone with a difference in means (95% confidence interval) of 0.61,” said Gerd Rüdiger Burmester, MD, professor of medicine, director, Department of Rheumatology and Clinical Immunology, University Medicine Berlin, who presented the study’s findings at European League Against Rheumatism 2019.

About one in three cancer survivors live with chronic pain, according to a research letter published in JAMA Oncology. The analysis included 4,526 cancer survivors, of whom 1,648 (34.6%) reported chronic pain and 768 (16.1%) reported high-impact chronic pain (HICP). When adjusting for the total cancer survivor population, this translates to roughly 5.39 million and 2.51 million cancer survivors nationwide with chronic pain and HICP, respectively. The prevalence of chronic pain or HICP did not vary based on age, sex, marital status, or region, but patients with less than a high school education were more likely to report chronic pain (39.2%) or HICP (18.5%), as were patients with low household income (44.6% and 22.8%, respectively), public insurance (among patients aged 18-64 years; 43.6% and 27.1%, respectively), or no paid employment (38.5% and 20.4%, respectively). In adjusted analyses, chronic pain was more prevalent among survivors of bone (54.0%), kidney (52.3%), throat-pharynx (47.9%), and uterine (44.5%) cancers