WIN-Session SpA/PsA beim Kongress der DGRh 2018 in Mannheim

Bei der WIN-Session SpA/PsA beim Kongress der DGRh 2018 in Mannheim (WIN steht für What is new?) kamen doch einige neue Erkenntnisse zur Sprache.

U. Kiltz zeigte Daten, die das Knochenmarködem an den Ileosakralgelenken in der MRT als diagnostisches Kriterium für Entzündung in Frage stellen, eher unspezifisches Merkmal. Die Röntgengrogression lässt sich häufiger an der Brustwirbelsäule darstellen; vielleicht muss hier ein Umdenken stattfinden. Ixekizumab und Bimekizumab sind in der Pipeline. Die Blockade von IL-23 ist für die ankylosierende Spondylitis nicht von Bedeutung (gezeigt an Risankizumab). Körperliche Aktivität sollte weiterhin "elementarer Bestandteil des Therapiekonzeptes" sein.

F. Behrens wies darauf hin, dass die Enthesen bei der Psoriasisarthritis von besonderer Bedeutung sind. Daher sind dort auch LI-23, IL-17, TNF-alpha und IL-22 von Bedeutung für Knochenneubildung, Knochenverlust, Knochenödem und Entzündung. Neu Erkenntnisse ergeben sich auch aus der Erforschung des Microbioms. Tofacitinib zeigt ein ähnliches Ansprechen im Vergleich zu Adalimumab. Die Daten zu Ixekizumab und Guselkumab waren in meinen Augen nicht so überzeugend, allerdings muss erst noch die Phase 3 Studie abgewartet werden.

J. Sieper ging der Frage nach, was der Unterschied zwischen peripherer Spondyloarthritis und seronegativer rheumatoider Arthritis ist. Er konnte verschiedene Unterschiede herausarbeiten. Gelenkbefallsmuster (Mon-/Oligoarthritis, eher untere Extremitäten, asymmetrisch gegenüber symmetrischer Polyarthritis eher kleiner Gelenke), Enthesitis und/oder Daktylitis gegen fehlen diese Merkmale, für die Spondyloarthritis sprechen noch: HLA B27, vorausgegangene Infektion, N. Crohn, Psoriasis, axiale Beteiligung.

PLENARSITZUNG

16:45 - 17:45 05 | WIN-Session SpA/PsA

Vorsitz: Frank Behrens, Frankfurt/Main

Denis Poddubnyy, Berlin

Treat-to-Target bei Spondyloarthritiden: wo sind wir, wo müssen wir hin?...

Josef Smolen, Wien, Österreich

WIN Axiale Spondyloarthritis

Uta Kiltz, Herne

WIN Psoriasis-Arthritis

Frank Behrens, Frankfurt/Main

Periphere Spondyloarthritis vs. Seronegative rheumatoide Arthritis - was ist der Unterschied?

Joachim Sieper, Berlin

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Guselkumab at the 2017 ACR Annual Meeting in San Diego

Guselkumab is a monoclonal antibody that targets the p19 subunit of IL-23. Guselkumab is marketed by Janssen-Cilag under the name of TREMFYA^® [maybe Xzkrkplk would have been easier to memorize]. The FDA approved TREMFYA™ (guselkumab) for the treatment of moderate to severe plaque psoriasis in July 2017 [1] and the EMA did equally in November 2017 [2].

Guselkumab showed up at the 2017 ACR Annual Meeting in San Diego with just one study [3].

A.A. Deodhar and colleagues presented a phase 2a study: “Efficacy and Safety Results of Guselkumab in Patients with Active Psoriatic Arthritis over 56 Weeks from a Phase 2a, Randomized, Double-Blind, Placebo-Controlled Study.” The authors concluded: “In pts [patients] with active PsA [psoriatic arthritis] and ≥3% BSA [body surface area] of psoriasis, GUS [guselkumab] demonstrated substantial benefits on joint symptoms, physical function, psoriasis, enthesitis, dactylitis, and quality of life, and efficacy was well-maintained through wk56 [week 56]. GUS was well-tolerated with no unexpected safety findings in this population after ~1 year of exposure.”

This study tells us that we might have a new drug against psoriatic arthritis and maybe then also against ankylosing spondylitis within a couple of years. There have to be some more phase 3 studies in arthritis ans spondyloarthritis before getting approval by FDA and EMA. I don’t think that Janssen-Cilag will not try to get approval for the treatment of psoriatic arthritis and ankylosing spondylitis.

Links and References:

[1] https://www.jnj.com/media-center/press-releases/janssen-announces-us-fda-approval-of-tremfya-guselkumab-for-the-treatment-of-moderate-to-severe-plaque-psoriasis

[2] https://www.presseportal.de/pm/16998/3795787

[3] Deodhar AA, Gottlieb AB, Boehncke WH, Dong B, Wang Y, Zhuang Y, Barchuk W, Xu XL, Hsia E. Efficacy and Safety Results of Guselkumab in Patients with Active Psoriatic Arthritis over 56 Weeks from a Phase 2a, Randomized, Double-Blind, Placebo-Controlled Study [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). http://acrabstracts.org/abstract/efficacy-and-safety-results-of-guselkumab-in-patients-with-active-psoriatic-arthritis-over-56-weeks-from-a-phase-2a-randomized-double-blind-placebo-controlled-study/. Accessed March 8, 2018.

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Guselkumab at the 2017 EULAR Annual Meeting in Madrid

You might never have heard about guselkumab, which targets IL-23. Other MABs targeting IL-23 include briakinumab (nothing at the EULAR 2017 meeting), tildrakizumab (nothing at the EULAR 2017 meeting), and ustekinumab (already available as Stelara). To be more specific: guselkumab (GUS) is a fully human monoclonal antibody (MAB) against the p19 subunit of IL-23.

A. Deodhar and colleagues published [1]: “EFFICACY AND SAFETY RESULTS OF GUSELKUMAB, AN ANTI-IL23 MONOCLONAL ANTIBODY, IN PATIENTS WITH ACTIVE PSORIATIC ARTHRITIS OVER 24 WEEKS: A PHASE 2A, RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED STUDY”. The authors concluded: “In pts with active PsA [psoriatic arthritis] and ≥3% BSA [Body Surface Area] of psoriasis, GUS demonstrated significant improvement on joint symptoms, physical function, psoriasis, enthesitis, dactylitis and quality of life. GUS was well tolerated with no unexpected safety findings in this population.”

It’s still too early to do projections into the future. A word of warning however: we had hardly any options to treat psoriatic arthritis for long time, now we see a proliferation of different principles. Psoriatic arthritis is less common than rheumatoid arthritis; PsA has a prevalence of 0.16-0.25 % and RA 0.5-1.0 % [2]. Though we are happy for any new therapeutic principle, we shall have a long way to put all the options into a working algorithm.

Links and References:

[1] Annals of the Rheumatic Diseases, volume 76, supplement 2, year 2017, page 142 / Session: PsA: the options grow! , (Oral Presentations ) /

DOI: 10.1136/annrheumdis-2017-eular.1164

[2] http://www.sciencedirect.com/science/article/pii/S0049017216300646

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What’s in the names of drugs in rheumatology?

As soon as I see drug names, I associate something. What’s in the names of drugs in rheumatology? I’ll show you some associations. Maybe you have even more or others; feel free to post these. Drugs in rheumatology doesn’t mean that only approved drugs will appear here.

Abatacept – close to abattoir.

Arava – do you also see the colorful parrot? And Ava like Ava Gardner. Some patients call the drug avara, which is close to awaara (awaara hoon, Hindi for I am a vagabond).

Celebrex - Oh, a celebration!

Cimzia – like the Italian female name Cinzia. But as the drug was introduced to Germany we thought more of Zimtzicke (bitchy cow).

Etanercept – too bad, eta are the outcasts in feudal Japanese society. Eta (穢多) means abundance of filth.

Guselkumab – looks a bit gruselig (creepy, gruesome). Or even like Gruselkabinett (chamber of horrors).

Humira – human, but the second half ira is Latin for wrath.

Lantarel – nobody could have expected, that later there’ll be a Lana del Rey. On the other hand lanta is Finnish for manure. Oops!

Leflunomide – Le flu comes to my mind, but in French it’s la gripe for flu.

Methotrexate – luckily people abbreviated methotrexate to MTX and not to Meth.

Orencia – I have called it Horrencia because of the high price and the German word horrend (horrendous). There also lies horror in the word.

Remicade – there is a tie or draw in the word because of remis.

RoActemra – in Germany tocilizumab is marketed as RoActemra and not as Actemra. Ro(che) acts on RA (rheumatoid arthritis). Good choice, but a but – ro in German means raw (roh).

Simponi – looks like symphony. The Supremes sang: “… I hear a symphony”. And that’s what you get, when you search on Twitter for instance, Indonesian or Malayan kids talking about simponi (songs, symphony). There’s even an Indonesian Pop band with the name Simponi.

… might be continued.