Rheumatology Month in Review: November 2024

This rheumatology month in review highlights new data from the American College of Rheumatology (ACR) Convergence 2024, held November 14-19 in Washington, DC, on fibromyalgia, gout, and lupus.

Advances in Fibromyalgia Management

Shreena K. Gandhi, MBBS: Recognizing Fibromyalgia as a Continuous Variable, Trait Diagnosis

HCPLive spoke with Shreena K. Gandhi, MBBS, resident, University of Kansas School of Medicine - Wichita, and Kansas City VA Medical Center, during the ACR meeting about her research into social security disability (SSD) in people who meet fibromyalgia criteria. The research found that these people do not receive SSD to the same rate as people with concurrent rheumatoid arthritis (RA) or osteoarthritis (OA) who meet fibromyalgia criteria, and functional status variables were the primary predictors of SSD.

“We should look at fibromyalgia more as a trait diagnosis, rather than a state diagnosis… A trait diagnosis is something that a patient has, but doesn't always have to show… what we're seeing time and again with fibromyalgia is that a lot of it is defined on a continuous variable scale… so, I do want that to be emphasized in practice,” Gandhi told HCPLive® during the meeting.

Functional Exercise Training Reduced Pain in People With Fibromyalgia

Other recent research in the fibromyalgia field found that functional exercise training was more effective at reducing pain and improving quality of life than stretching exercises in patients with fibromyalgia.

The investigators found that after 14 weeks, the function exercise group had a statistically significant reduction in pain (interaction P = .002), improvement in health-related quality of life as measured by FIQ (interaction P < .001), and improvement in general health state domain of SF-36 (interaction P = .043) compared to the stretching exercise group. The investigators did not find any significant differences in functional capacity, muscle strength, flexibility or balance improvements between the functional exercise and the stretching exercise groups.

Delaying Organ Damage and Reducing Corticosteroids in SLE

DZP Improves Disease Activity and Reduces Corticosteroid Use in SLE

Dapirolizumab Pegol (DZP) was superior to placebo in achieving responses in patients with systemic lupus erythematosus (SLE) and permitted corticosteroid tapering in new data from the phase 3 PHOENYCS GO trial (NCT04294667).

The trial met its primary endpoint, with 49.5% (n = 103) of the DZP group and 34.6% (n = 37) of the placebo group achieving BICLA response at week (P = .0110; difference, 14.6% [95% CI, 3.3-25.8]). Similarly, 60.1% (n = 125) of the DZP group and 41.1% (n = 44) of the placebo group achieved SRI-4 response at week 48 (nominal P = .0014; difference, 18.8% [95% CI, 7.3-30.3]).

Anifrolumab Delayed Onset of Organ Damage in Patients With SLE

Patients with moderate-to-severe SLE that were treated with long-term anifrolumab had lower rates of damage accrual and a delayed onset of irreversible organ damage.

Data from the phase 3 LASER study (NCT06485674) found that patients receiving SOC had a greater increase in SLICC/ACR Damage Index (SDI) than those treated with anifrolumab after 4 years. Propensity score matching (PSM) found that the anifrolumab arm had a mean 0.201 (95% CI, 0.119–0.283) and the SOC arm had a mean 0.571 (95% CI, 0.380–0.761) change in SDI (mean difference –0.370; P = .002). Overall, patients in the anifrolumab arm had a 59.9% lower risk of first SDI progression over 48 months compared with SOC (hazard ratio, 0.401 [95% CI, 0.213–0.753]; P <.01).

Reducing Treatment Burden for Patients With Gout

Shortened Pegloticase Infusions Feasible for Uncontrolled Gout, Reduces Treatment Burden

Shortened, 1-hour infusion times of pegloticase (Krystexxa; Amgen) in combination with methotrexate were well-tolerated with preserved efficacy in patients with uncontrolled gout, demonstrating a promising option for reducing treatment burden.

The IR rate was 6.0% (95%CI, 2.5-12.0%; n = 7) in the mITT group, including anaphylaxis (AR) in 2 patients (1.7%). AGILE met its primary endpoint, with the upper 95% CI bound for IR rate being less than 13% (as per a prespecified threshold)1 and similar to the 4.2% (including AR in 1.0%) in a prior pegloticase+MTX registrational trial with 120-min infusions (MIRROR RCT).2 The SU-response rate (SU < 6 mg/dL for ≥80% of Weeks 20-24 during Month 6) secondary endpoint was also met, with a 67.2% rate (95%CI, 57.9-75.7%) compared with 74.0%.

Urate-Lowering Therapy Remains Tolerable in Patients with Gout, CKD

Targeting urate-lowering therapy (ULT) to achieve serum urate levels ≤6 mg/dL did not elevate the risk of severe or end-stage kidney disease progression in patients with gout and chronic kidney disease (CKD) stage 3, according to a new cohort study in JAMA Internal Medicine.

Among those who met the inclusion criteria, the primary analysis included 14,792 participants (mean age, 73.1 years; 9215 men [62.3%] and 5577 women [37.7%]) with gout and CKD stage 3. Of those who initiated ULT, 4706 (31.8%) achieved target serum urate level (TSUL) within 1 year of the index date.

Upon analysis, the 5-year risk of severe or end-stage kidney disease was 10.32% for those who achieved the target serum urate level and 12.73% for those who did not meet the goal. In comparison with those who did not achieve target levels, the adjusted 5-year risk difference and HR of severe or end-stage kidney disease for patients achieving TSUL was –2.41% (95% CI, –4.61 to –0.21) and 0.89 (95% CI, 0.80 to 0.98), respectively.