PHILADELPHIA—Expert panelists gathered in the closing session at ACR Convergence 2022 to give their take on what they saw as some of the most notable research findings and other insights to come out of the meeting, touching on a number of topics on the leading edge of the field.
COVID-19 Prophylaxis & Vaccinations
Alfred Kim, MD, PhD, assistant professor of rheumatology at Washington University in St. Louis, Mo., mentioned studies that he said help clarify how to navigate COVID-19 treatments and vaccinations for people with rheumatic disease.
Patients receiving B cell depleting therapies for immune-mediated inflammatory diseases (IMIDs) who develop COVID-19 have a high risk of poor outcomes. Pre-exposure prophylaxis with tixagevimab/cilgavimab (Evusheld) has been available under an Emergency Use Authorization from the U.S. Food & Drug Administration since December 2021.
In a study out of the Cleveland Clinic, Calabrese et al. assessed the outcomes of more than 400 patients with IMID who were treated with tixagevimab/cilgavimab for COVID-19 prevention and had been vaccinated against COVID-19.1 They found that only 13 patients had a breakthrough COVID-19 infection. Twelve of those had a mild disease course and recovered at home; one patient was hospitalized, but there were no deaths.
In another study of nearly 1,300 adult patients with autoimmune diseases who had had at least two doses of COVID-19 vaccine, Connolly et al. found that a third dose was associated with a reduced risk of a breakthrough infection during the Omicron wave.2
“I think there’s … good data … to give [our patients] confidence and push them in the right mind state [to] feel they can get these additional doses,” Dr. Kim said.
RA Prevention
Kristine Kuhn, MD, PhD, associate professor of rheumatology at the University of Colorado, Denver, noted the findings of the StopRA trial, which found that hydroxychloroquine did not seem to prevent development of RA in people with anti-CCP antibodies.3
“Unfortunately, it was a negative trial, but I think we are all waiting to see what the detailed results of that will be,” Dr. Kuhn said. She said the concept of prevention in those at risk is still viable.
“We’re getting better at identifying who we might want to intervene on at an earlier time point, but then I think we’ve got to get better at identifying the right medication,” she said.
Diet & Exercise for Knee OA
Daniel K. White, PT, ScD, associate professor at the University of Delaware, Newark, said a trial looking at intensive diet and exercise for patients with osteoarthritis (OA) was important because it was conducted in the community setting.4
“It answers the question whether or not we can implement a diet and exercise intervention into the community setting rather than in a research laboratory,” he said.
Researchers saw a significant decline in pain, to a clinically significant degree, in the diet and exercise group, Dr. White said.
“It’s really exciting stuff from our perspective,” he said. “Only a third of physicians recommend exercise to their patients, and this study supports the need for this to change.”
Urinary Biomarkers for LN
Dr. Kim discussed a study out of Johns Hopkins through the Accelerating Medicines Partnership that found that urinary interleukin (IL) 16 is associated with the proliferative form of lupus nephritis (LN).5 He said this makes sense because immune cells that make IL-16 are localized in the most vulnerable part of the kidney in patients with LN, the glomerulus and interstitium.
“I think this is really an important observation; it also allows us to find those people with proliferative lesions more easily,” he said.
He said IL-16 has been validated in other studies, making it a lead biomarker for LN. Nevertheless, he said, the findings need validation and there would likely be “more power” in the diagnostic powers of biomarkers when taken together.
“I think it’s naive to think that one biomarker is going to fix everything,” Dr. Kim said.
Balance of Daily Activities & RA
Dr. White said he was struck by an ACR session on finding the right balance in daily life for people with RA.
Experts at the University of British Columbia, Vancouver, who have studied the totality of daily activities—sitting, sleeping, exercise and other activity over an entire 24 hours—said the idea is to be mindful of “not only how much physical activity you should do, but also how much rest you should have and how much down time you should have,” Dr. White said. The discussion stemmed from studies analyzing the activity and sleep patterns of people with rheumatic diseases.6
Dr. Kuhn said assessing functional outcomes using an approach like this will be important as clinicians turn to treat-to-target strategies.
“Are we really hitting a target if our patient doesn’t feel better?” she said.
CAR T Cell Therapy in SLE
Dr. Kim discussed the excitement surrounding findings of efficacy for chimeric antigen receptor (CAR) T cell therapy in five patients with refractory systemic lupus erythematosus (SLE), all of whom achieved remission.7
The first patient had numerous manifestations of SLE and had previously failed several medications.
“This patient is now over 600 days out. No disease activity in the interim. And is not on any other immunosuppression,” Dr. Kim said.
Peter Merkel, MD, chief of rheumatology at the University of Pennsylvania, said there “a long way to go, but this is very exciting.”
Chimeric Autoantigen T Cell Receptor Therapy
Dr. Kuhn said there is also a lot of excitement around findings showing the possibility of selectively targeting autoreactive B cells with chimeric autoantigen T cell receptor therapy.8
“You could potentially engineer a T cell receptor with an autoantigen that then could selectively deplete those B cells making autoreactive antibodies,” she said. This approach would be limited in diseases where it isn’t known what the autoantigen is, she said, but “it’s that proof of concept that this could be a way to really selectively get at the bad B cells and leave your good B cells behind.”
Thomas R. Collins is a freelance medical writer based in Florida.
References
- Calabrese C, Kirchner E, Villa Forte A, et al. Early experience of breakthrough COVID-19 infections in patients who received pre-exposure prophylaxis with tixagevimab/cilgavimab [abstract]. Arthritis Rheumatol. 2022;74(suppl 9).
- Connolly C, Wallwork R, Chiang TPY, et al. Three dose SARS-CoV-2 vaccination is associated with reduced risk of breakthrough COVID-19 during omicron wave in patients with autoimmune diseases [abstract]. Arthritis Rheumatol. 2022;74(suppl 9).
- Dean KD, Striebich C, Feser M, et al. Hydroxychloroquine does not prevent the future development of rheumatoid arthritis in a population with baseline high levels of antibodies to citrullinated protein antigens and absence of inflammatory arthritis: Interim analysis of the StopRA trial [abstract]. Arthritis Rheumatol. 2022;74(suppl 9).
- Messier S, Beavers D, Queen K, et al. Effectiveness of intensive diet and exercise on knee pain among communities with knee osteoarthritis, overweight, and obesity: The WE-CAN pragmatic randomized clinical trial. Arthritis Rheumatol. 2022;74(suppl 9).
- Fava A, Buyon J, Mohan C, et al. Urine proteomics and single cell transcriptomics identify IL-16 as a biomarker for lupus nephritis [abstract]. Arthritis Rheumatol. 2020;72(suppl 10).
- Feehan LM, Lu N, Xie H, et al. Twenty-four hour activity and sleep profiles for adults living with arthritis: Habits matter. Arthritis Care Res (Hoboken). 2020 Dec;72(12):1678–1686.
- Schett G, Boltz, S, Muller F, et al. CAR T cell treatment of refractory systemic lupus erythematosus [abstract]. Arthritis Rheumatol. 2022;74(suppl 9).
- Mog B, Shaw ER, Hwang MS, et al. Chimeric autoantigen-T cell receptor (CATCR)-T cell therapies to selectively target autoreactive B cells. Arthritis Rheumatol. 2022;74(suppl 9).
