Rheumatology Month in Review: October 2024

The rheumatology month in review highlights new data supporting the use of secukinumab for treating psoriatic arthritis (PsA), studies examining clinical decision making for clinicians treating gout, and the role of sleep in fibromyalgia.

New Data Supports Secukinumab Treatment for PsA

Secukinumab, Adalimumab Have Distinct Advantages for Treating PsA

Secukinumab and adalimumab are both effective at treating PsA, but secukinumab was more suitable for severe skin involvement and adalimumab for significant ultrasound-confirmed synovitis, according to a new prospective cohort study.

In 116 participants from the PARWCH database that attended the department of dermatology at West China Hospital between 2020 and October 2022, there was no significant difference in ACR20 response between participants on secukinumab or adalimumab at week 12, but secukinumab demonstrated superior efficacy in achieving Psoriasis Area and Severity Index (PASI)90 (OR, 2.25; 95% CI, 1.07 – 3.74; P = .03) and adalimumab demonstrated better improvement in ultrasound synovitis count (β: 0.94, 95% CI: 0.09 – 1.79, P = .03) and synovitis PD signal (β: 0.20, 95% CI: 0.03 –0.36, P = .02).

IV Secukinumab Rapidly Improved Clinical Responses in Psoriatic Arthritis

Results from the placebo-controlled Phase 3 INVIGORATE-2 study demonstrated the benefit of intravenous (IV) secukinumab for the rapid improvement of disease signs and symptoms in patients with active PsA.

Compared with placebo, all primary and secondary efficacy endpoints for secukinumab achieved statistical significance (all adjusted P <.05). A significantly greater proportion of patients receiving IV secukinumab achieved the primary endpoint of ACR50 response rates at Week 16 compared with placebo (31.4% vs. 6.3%; adjusted P <.0001).

Research Aims to Improve Gout Clinical Decision Making

Simplified Gout Remission Definition Feasible, Valid

A simplified gout remission definition was a feasible and valid option when compared with the 2016 preliminary gout remission definition when compared in a study of nurse-led and usual (general practitioner) care.

Participants in the nurse-led care group were more likely to achieve remission using either definition at year 2 compared with the group receiving usual care. Participants that achieved remission according to either definition had better gout outcomes via the GIS, including greater control over their gout, worry about future gout attacks, gout disease progression and its interference in future activities, and efficacy of gout medication, than those who did not.

Radiomics Model Distinguishes Gout Flares, May Improve Clinical Decision Making

A radiomics model was able to distinguish patients with and without gout flares in a new analysis and may have potential in facilitating the clinical decision-making process for treating gout. The model used 4 radiomic features that investigators found distinguished patients with at least 1 flare from those without flares.

The radiomic model having an area under the receiver operating characteristic curve (AUC) of 0.76 (95% CI, 0.69-0.83), the clinical model having an AUC of 0.72(95% CI, 0.63-0.80), and the comprehensive model having an AUC of 0.79 (95% CI, 0.73-0.86). The differentiated values of the comprehensive model agreed well with the actual values as seen on calibration curves (P >.05).

Fibromyalgia News Highlights Sleep Issues

Tonix Pharma Submits NDA for TNX-102 SL, Potential Fibromyalgia Medication

Tonix Pharmaceuticals has submitted a new drug application (NDA) for its non-opioid, centrally acting analgesic TNX-102 SL for the proposed treatment of fibromyalgia. TNX-102 SL is a cyclobenzaprine hydrochloric acid sublingual tablet medication and targets non-restorative sleep characteristic of fibromyalgia.

The NDA submission is supported by the phase 3 RELIEF trial that met its pre-specified primary endpoint of significantly reducing daily pain compared to placebo (P = .010) and the phase 3 RESILIENT trial that also met the pre-specified primary endpoint of significantly reducing daily pain compared to placebo (P.= .00005).

Long-term Opioids for Fibromyalgia Linked to Depression, Sleep Issues

A retrospective cohort analysis has found that patients with fibromyalgia who continue opioid use beyond 90 days are at significantly greater risk of developing depression or a sleep disorder.

Adjusted analyses showed that long-term opioid use was linked to a 58% increased risk of depression (hazard ratio [HR], 1.58; 95% CI, 1.29 – 1.95) and 30% increased risk of sleep disorders (HR, 1.30; 95% CI, 1.09 – 1.55).