Never Too Late: Late-Breaking Abstracts Create Excitement

Methotrexate & AstraZeneca COVID-19 Vaccine

In the fourth presentation of the session, Anu Sreekanth, MD, Sree Sudheendra Medical Mission, Kochi, India, discussed the effects of withdrawing methotrexate after both doses vs. after only the second dose of the ChAdOx1 nCoV-19 vaccine (from AstraZeneca) among patients with autoimmune inflammatory arthritis.

In this study, the authors recruited patients with rheumatoid arthritis or psoriatic arthritis on a stable dose of methotrexate without prior COVID-19 infection. Unvaccinated patients were randomized to either hold or continue methotrexate for two weeks after each dose of the vaccine. For patients who had continued methotrexate during their first dose of the vaccine, these individuals were randomized to hold or continue methotrexate for two weeks after the second dose of the vaccine.

The authors found that holding methotrexate after both doses or only after the second vaccine dose yielded higher anti-receptor binding domain antibody titers than continuing methotrexate. In addition, holding methotrexate after only the second dose appeared to be non-inferior to holding methotrexate after both doses of the vaccine, with a lower risk of flare.⁴

Dr. Dasgupta

Sarilumab for Relapsing Polymyalgia Rheumatica

In the penultimate presentation, Bhaskar Dasgupta, MBBS, MD, FRCP, consultant rheumatologist, The London Clinic, England, discussed the efficacy of sarilumab in patients with relapsing polymyalgia rheumatica (PMR). Sarilumab is a fully human anti-IL-6Rα monoclonal antibody.

In this study, patients with PMR who had flared on ≥7.5 mg/day prednisone or equivalent were randomized to 52 weeks of treatment with 200 mg of sarilumab every two weeks plus a 14-week glucocorticoid tapering regimen, or placebo every two weeks plus a 52-week glucocorticoid tapering regimen.

The primary end point in the study was the proportion of patients achieving sustained remission at week 52—as defined by remission at week 12, absence of disease flare, C-reactive protein normalization from weeks 12–52 and adherence to the protocolized glucocorticoid taper from weeks 12–52. Sustained remission rate was significantly higher in the sarilumab arm vs. the comparator arm (28.3% vs. 10.3%; P=0.0193), and patients in the sarilumab arm were 44% less likely to have a flare after achieving clinical remission compared with patients in the comparator arm (16.7% vs. 29.3%; HR 0.56; 95% CI 0.35–0.90; P=0.0158).

Dr. Dasgupta noted the study was terminated early because of prolonged recruitment timelines during the COVID-19 pandemic. However, using the data that was collected, the authors concluded that sarilumab with a 14-week glucocorticoid taper showed significant efficacy compared with the comparator arm in glucocorticoid-refractory PMR patients, including clinically meaningful improvement in quality of life.⁵ This could represent a notable additional therapy in this often difficult-to-treat condition.