RA in the News at EULAR

Use of the newer biologic agents in the treatment of patients who have arthritis does not increase their risk of cancer, according to data presented at the 2011 Annual Congress of the European League Against Rheumatism (EULAR), held recently in London.

A first cancer developed in only 3% of more than 13,000 patients in the study cohort who received anti–tumor necrosis factor α (anti–TNF-α) therapy for their arthritis within 9 years. Overall risk was not dependent on the type of arthritis (rheumatoid arthritis [RA], psoriatic arthritis, or ankylosing spondylitis). The authors noted that this study provides long-term evidence that an overall risk for cancer is not associated with this group of treatments.

In another study, mortality rates were compared among 3431 patients treated with the anti–TNF-α agent etanercept and 1365 patients treated with disease-modifying antirheumatic drugs (DMARDs). Crude mortality rates were lower in the etanercept group (1.31% vs 2.27%), although the difference did not reach statistical significance in the more conservative of the scenarios.

Other key study findings at EULAR 2011 that involved RA include the following:

•Patients with RA are significantly less likely to have standard post–myocardial infarction (MI) treatments prescribed for them than are healthy persons after a first-time MI. At 30 days after their first heart attack, patients with RA were about 20% less likely to have standard MI treatments, such as statins and β-blockers, prescribed for them than were healthy patients, and the finding remained relatively unchanged at 180 days. The study authors suggested that cardiovascular disease may be undertreated in patients with RA because of clinicians’ concerns about the use of multiple medications and patients’ adherence to treatment.

•Patients with RA who are receiving DMARDs show significantly less protection from pandemic influenza after they receive the H1N1 vaccine than healthy persons. Because the study results highlighted differences in the level of protection between the H1N1 vaccine and the seasonal influenza vaccine, clinicians should not assume that immune response will be the same with different vaccines, and they should consider specific immunization strategies to ensure that patients are as fully protected from pandemic flu as possible, it was noted.

•Patients with RA are 2 times more likely to have concurrent chronic obstructive pulmonary disease than healthy persons. This association is sustained even when age, sex, cigarette smoking, obesity, and other variables are controlled for.

•In a 12-month multinational study, 58.3% of patients who previously had not responded to treatment with DMARDs achieved an American College of Rheumatology 20 response at 6 months when treated with the novel oral Janus kinase inhibitor tofacitinib at 10 mg bid compared with 31.2% in the placebo group. Significant improvements also were observed with a 5-mg bid dose. Most adverse events were mild, and no new safety signals were reported, according to the study authors.

•Initial treatment with adalimumab plus methotrexate (MTX) in patients with early RA can provide high levels of disease control in many patients and may offer the opportunity to change future treatment options for some. Of patients treated with the combination therapy, 44% achieved the target of sustained low disease activity at week 26, compared with 24% of those treated with MTX alone. The results demonstrated that it may be possible to successfully withdraw anti–TNF-α therapy in some patients and maintain long-term positive outcomes, it was suggested.

•Findings from a subgroup analysis of the REALISTIC (RA Evaluation in Subjects Receiving TNF Inhibitor Certolizumab Pegol) study indicated that certolizumab pegol shows rapid and sustained efficacy in a diverse group of patients with RA. Statistically significant improvements were seen in patients who received the agent as monotherapy or in combination with other DMARDs and in those for whom previous anti–TNF-α therapy was not successful or who never used such therapy. Improvements were seen as early as the second week of treatment. Symptoms that patients identified as especially important to their quality of life included reduced fatigue, sleep problems, and pain.

For more information about these and other developments at the meeting, visit the EULAR Web site at http://www.eular.org. Or, contact the organization at European League Against Rheumatism, EULAR Secretariat, Seestrasse 240, CH 8802 Kilchberg, Switzerland; telephone: +41 44 716 30 30; fax: +41 44 716 30 39.