High Points of Rheumatology in 2013

Dec 23, 2013

Article

Biosimilars, advances in treatment for rheumatoid and juvenile arthritis, numerous new guidelines and drug approvals. Review the past year's progress in rheumatology, as compiled by our Editorial Board.

Compiled based on choices from the RheumatologyNetwork Editorial Board.

Biosimilars

The European Commission approved the infliximab biosimilar Remsima for RA and ankylosing spondylitis, based on PLANETRA^1,2 and PLANETAS^3,4 studies, respectively.
Efficacy of etanercept biosimilar Infinitam found similar to that of innovator etanercept in rheumatoid arthritis.⁵

Advances in RA Treatment

The RACAT trial suggested that three older medications for RA used concomitantly may be as effective as biologics for non-responders to methotrexate, and substantially less expensive.⁶
The OPTIMA trial demonstrated that initiating therapy with adalimumab as well as methotrexate increased the proportion of patients reaching a low disease activity target, compared with methotrexate monotherapy.⁷
Two head-to-head trials: (1) Abatacept (Orencia) vs adalimumab (Humira), in which the agents were found equally effective with or without concomitant MTX, although the latter caused more injection-site reactions,⁸ and (2) IV tocilizumab vs adalimumab monotherapy in patients ineligible for continued MTX treatment.⁹ Tocilizumab proved superior in reducing RA symptoms but also caused potentially worrisome changes in blood test results.

New Guidelines

EULAR announced (but has not yet published) an update of its 2010 guidelines on RA.
ACR updated its 2011 recommendations for treatment of juvenile idiopathic arthritis (JIA) to include new medications.¹⁰
ACR and EULAR jointly updated classification criteria for systemic sclerosis.¹¹
ACR created two lists of tests and procedures that may be unnecessary, one for adults and one for younger patients.
A EULAR task force clarified how to incorporate erosions when classifying RA.¹²
EULAR issued recommendations for the imaging of joints in RA.¹³

New FDA Drug Approvals

Intravenous golimumab (Simponi Aria), a TNF inhibitor, for moderate to severe RA, in combination with methotrexate. The dosing regimen is shorter and less frequent than the previously approved subcutaneous formulation.
Subcutaneous tocilizumab (Actemra) for adults with moderate to severely active RA who have not responded to methotrexate or other DMARDs. An IV formulation was approved in 2010.
Ustekinumab (Stelara), an IL-12/23 inhibitor, and certolizumab pegol, a TNF inhibitor, both for psoriatic arthritis.
Anakinra for adults and children with neonatal-onset multisystem inflammatory disease (NOMID), a rare genetic disorder.
Tocilizumab for polyarticular JIA in children at least 2 years old. (It was already approved for systemic JIA.)
Canakinumab (Ilaris), an IL-1-beta inhibitor, for systemic JIA, in patients 2 years old or older.

Cause for Caution on Meniscal Tear

A randomized study found nonsurgical measures as effective as meniscectomy after 6 and 12 months for patients with torn meniscus and evidence of osteoarthritis.¹⁴

New Alternative for ANCA-Associated Vasculitis

Four weeks of rituximab therapy found as effective as a year and a half of cyclophosphamide and azathioprine for patients with severe antineutrophil cytoplasmic antibody-associated vasculitis. Side effects were similar.¹⁵