Arthritis
Dr. Seo continued his talk with good news: “We all have excellent job security.” He highlighted results from studies assessing the global prevalence of osteoarthritis (OA) and “other musculoskeletal disease,” like systemic lupus erythematosus (SLE) and spondyloarthritis.6,7 These studies showed that by 2020, 595 million people had OA and 494 million had “other musculoskeletal diseases,” representing a 132% increase and 123% increase since 1990 respectively. The prevalence of knee OA is expected to increase by 75%, and other musculoskeletal diseases by 50% by 2050.
Next, Dr. Seo turned toward RA trial design, highlighting NORD-STAR, a study with an admirable approach.8 He said, “If you think about the classic RA trial, they take a novel compound with really interesting mechanism of action and compare it to dishwater, or something else you don’t care about, like continuing methotrexate therapy in a patient who has already failed methotrexate. What we really need are clinical trials where all the arms are looking at interventions that we might actually use.”
NORD-STAR took patients with treatment-naive early, active RA, and randomized them to receive “active conventional therapy” (methotrexate and tapered steroids, or triple therapy with methotrexate, sulfasalazine and hydroxychloroquine, as well as intra-articular glucocorticoids as needed), or methotrexate plus a biologic (e.g., abatacept, certolizumab pegol or tocilizumab).8 Results showed that “compared with active conventional therapy, [Clinical Disease Activity Index (CDAI)] remission rates were significantly higher for abatacept (adjusted difference +20.1%, P<0.001) and certolizumab (+13.1%, P=0.021), but not for tocilizumab (+12.7%, P=0.030).8
“I think that NORD-STAR really highlights that abatacept belongs higher in the hierarchy of drugs we consider when looking at patients with new RA,” said Dr. Seo.
Last, Dr. Seo discussed interesting findings from an exploratory analysis of LoDoCo2, a cardiology trial that examined the effect of colchicine in patients with coronary artery disease (CAD).9 The study found that patients assigned to colchicine 0.5mg daily had a decreased risk of developing a need for hip or knee replacement in the future (HR 0.69; CI 0.51-0.95). Similarly, an exploratory analysis of CANTOS, a cardiology trial examining canakinumab in patients with CAD, found a similar decreased risk of hip or knee replacement a few years ago (HR 0.58; CI 0.42-0.80).10 “None of us are going to go out and start giving canakinumab to a bunch of patients to prevent OA, but colchicine certainly raises some intriguing opportunities. I’ll be interested to see whether colchicine is effective for even earlier complications of OA besides joint replacement,” Dr. Seo remarked.
