Rheumatology Month in Review: November 2023


In the November 2023 rheumatology month in review, our editorial team highlights ACR conference coverage, the latest updates in fibromyalgia, and advancements in patient care.

Rheumatology Month in Review: November 2023

The rheumatology month in review highlights top data from the American College of Rheumatology’s 2023 Convergence, the link between psychiatric symptoms and disease activity in patients with fibromyalgia, and advancements in patient care via exciting collaborations and patient education.

Highlights From ACR 2023

HCPLive traveled to San Diego to cover the American College of Rheumatology’s 2023 Convergence, which ran from November 10 – 15. Coverage included a broad scope of topics featuring new data demonstrating a local injection of TLC599 could alleviate pain in patients with knee osteoarthritis, sustained remission in patients receiving rituximab and concomitant avacopan, and greater improvements in both mean spine pain and morning stiffness with bimekizumab treatment.

TLC599 Injection Shown to be Effective for Daily Pain in Patients with Osteoarthritis of the Knee

The drug TLC599 was more effective than placebo in improving both average daily pain (ADP) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain for patients with osteoarthritis of the knee. Findings indicated both ADP and WOMAC pain showed improvement following a single injection, which was sustained up to 24 weeks. The next injection of TLC599 at the 24-week mark led to continued benefits to 52 weeks.

Rituximab Plus Avacopan Increases Remission Rates in ANCA-Associated Vasculitis

In the randomized, double-blind phase 3 ADVOCATE trial, investigators evaluated whether avacopan, an oral selective C5a receptor inhibitor, could replace a glucocorticoid-tapering schedule. Patients were categorized by ANCA status (either anti-proteinase 3 [PR3] positive or anti-myeloperoxidase positive), vasculitis disease status (relapsing or newly diagnosed), and immunosuppressive treatment (cyclophosphamide [CYC] or RTX).

At the 26-week mark, 77.6% of patients in the avacopan group and 75.7% of patients in the prednisone group achieved remission. However, sustained remission was obtained in 71.0% of patients receiving avacopan and 56.1% of those treated with prednisone at week 52.

Bimekizumab Improves Spinal Pain, Fatigue, Morning Stiffness in axSpA

At the American College of Rheumatology’s 2023 Convergence, Philip Mease, MD, director of Rheumatology Research at the Swedish Medical Center in Seattle, reported on the impact of bimekizumab in this patient population on patient-reported symptoms.

Both trials included a 16-week double-blind period followed by a 36-week maintenance period. Participants were randomized to receive either subcutaneous bimekizumab 160 mg every 4 weeks (Q4W) or placebo. At week 16, all subjects received bimekizumab.

At week 16, patients in the bimekizumab cohort achieved greater improvements in Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue scores compared with placebo, with similar results among the initial treatment group and those who switched. Additionally, a higher proportion of patients in the bimekizumab group were able to achieve ≥8-point improvement from baseline when compared with placebo at week 16, which were sustained through week 52.

Top Fibromyalgia Headlines

Among the top fibromyalgia coverage of November, a recent study revealed patients with fibromyalgia had more somatization symptoms compared with healthy subjects and greater levels of self-stigmatization. Results of another study demonstrated rumination induction after physical activity stunted patients’ recovery regarding discomfort and pain intensity compared with those using a distraction method.

Increases in Psychiatric Symptoms Lead to Greater Disease Activity in Fibromyalgia

The cross-sectional prospective study assessed psychiatric symptoms in these patients, as well as their concerns about stigma and their beliefs about seeking psychological help. The possible link between stigma concerns and not seeking psychiatric treatment was also evaluated.

Although all patients reported positive attitudes towards seeking psychiatric help, the self-stigmatization scores of seeking help were higher in patients with fibromyalgia compared with controls. Additionally, as fibromyalgia impact increased, self-stigmatization scores increased proportionally.

“Self-stigmatization behavior may be one of the barriers to getting psychiatric help in this patient group,” investigators concluded.

Rumination Limits Post-Exercise Recovery in Fibromyalgia

Rumination, which is defined as a chain of repetitive, passive, and somewhat uncontrollable negative thoughts, is common among this patient population and has been linked to higher pain intensity and worse outcomes. This may be due in part to previous experiences of pain itself and used as a coping strategy. Rumination may also play a role in limiting or reestablishing an exercise routine.

Results demonstrated rumination induction after physical activity stunted patients’ recovery regarding discomfort and pain intensity when compared with patients using the distraction method. Although both groups observed a decrease in pain intensity, this was greater in the distraction cohort. Decreases in discomfort linked to pain were only reported in the distraction group.

Advancing Patient Care

Organizations such as The Rheumatology Foundation, Lupus Therapeutics, and the Lupus Research Alliance are committed to advancing research in rheumatology to improve the lives of patients. This month, HCPLive had the opportunity to meet with 2 experts from these organizations to discuss some exciting developments aimed to positively impact patient care.

V Michael Holers, MD: Bridging the Gap Between Research and Patient Impact

Holers, president of the Rheumatology Research Foundation, sat down with HCPLive to discuss the creation of Rheumatology Lab in response to a pressing need within the clinical practice community to effectively bridge the gap between research and its impact on patients.

“I want to emphasize that this initiative was primarily driven by our patient and patient family representatives, who recognized the need for this type of information,” he explained. “We've always strived to be responsive to our community, and in this case, they brought this crucial gap to our attention. We're excited about this new venture and look forward to optimizing its impact.”

Stacie Bell, PhD: Lupus Therapeutics and AbbVie to Join Forces for Promising Lupus Treatment Program

In an interview with HCPLive, Stacie Bell, PhD, executive vice president of Lupus Therapeutics, the clinical research affiliate of the Lupus Research Alliance, discussed the announcement of their partnership with AbbVie for the phase 3 clinical program of upadacitinib in patients with systemic lupus erythematosus (SLE). Lupus Therapeutics will help with study participant recruitment, engagement, and site activation through the Lupus Clinical Investigators Network (LuCIN) throughout North America.

Bell and her team hope to see positive outcomes in the clinical trial, although the results will be determined through the evaluation process. AbbVie will collaborate with regulatory authorities to progress to the next development and approval stage. Ultimately, the study represents an opportunity to evaluate a new potential treatment option and potentially bring it to the patient community.

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