ACR CONVERGENCE 2021—During Plenary Session 1 of ACR Convergence 2021, Nov. 6, researchers from around the U.S. and the world presented new findings that may help pave the way for better treatment strategies. They discussed research on the prevention of rheumatoid arthritis (RA) in at-risk people, a deeper understanding of COVID-19 vaccination in those with chronic inflammatory conditions and more. Here are the highlights.
COVID-19 Vaccination & Chronic Inflammatory Conditions
Dr. Alfred Kim
A study on COVID-19 vaccination in people with chronic inflammatory conditions (COVaRiPAD) found almost all patients mount an antibody response, but with titers that are 3.4-fold lower than immunocompetent controls,1 said Alfred Kim, MD, PhD, assistant professor of medicine at Washington University in St. Louis.
Given the dramatic reduction in response with B cell depletion, patients on this therapy are encouraged to receive vaccination about a month before their next scheduled dose to maximize the time between their previous dose and their COVID-19 shot, Dr. Kim said.
Researchers are continuing to look at the durability of immune responses and to assess the impact of disease state, he said.
Risankizumab & PsA
Dr. Andrew Ostor
The monoclonal antibody risankizumab performed significantly better than placebo at controlling the signs and symptoms of psoriatic arthritis (PsA) in patients who had a poor response to, or intolerance of, at least one conventional synthetic disease-modifying anti-rheumatic drug (DMARD),2 said Andrew Ostor, MD, adjunct associate professor at Monash University, Melbourne, Australia.
“Risankizumab was well tolerated and showed no new safety signals,” he said in his presentation. The drug is already approved to treat moderate to severe plaque psoriasis.
In the trial, 707 patients with a disease onset of at least six months before screening were randomized to receive 150 mg of risankizumab. Seven hundred patients were in the placebo group.
Patients in the risankizumab group had significantly higher rates of ACR20, 50 and 70 responses at 24 weeks after the start of treatment (P<0.001) than patients in the placebo group. They also had higher scores on the Psoriasis Area Severity Index (PASI) 90 (P<0.001) and better performance on the Health Assessment Questionnaire-Disability Index (HAQ-DI; P<0.001) than patients in the placebo group.
Those in the treatment group also had significantly higher rates of minimal disease activity at 24 weeks, Dr. Ostor said.
Disparity by Race & Neighborhood
Dr. Ram Singh
From 1999 to 2019, 8,899 deaths in the U.S. were attributed to lupus nephritis, with death rates due to the condition declining by 27% during this time.3 But from 2014 to 2019, the death rates began to rise, said Ram Singh, MD, professor of medicine at the University of California, Los Angeles.
The findings came from an analysis of data from the U.S. Centers for Disease Control and Prevention’s WONDER database on public health.
Researchers also found that, compared with white people, death rates from lupus nephritis were 6.1 times higher over that period for Black people, about 2.2 times higher for Hispanics, about 2.0 times higher for Asians and about 2.7 times higher for Native Americans.
Looking at urbanization, researchers found the highest death rates from lupus nephritis were in large, central metro areas—essentially inner cities—while living in large, fringe metropolitan area—essentially suburbs—was associated with the lowest death rates.
They also found race had a different effect on the risk of death from lupus nephritis in different urbanization areas. Example: Hispanics had a much higher mortality rate in large central metro areas than they did in all other urbanization zones, while Black race had relatively little effect on lupus nephritis mortality risk across urbanization zones.
Both race and residence are independently associated with lupus nephritis mortality, according to Dr. Singh. “Urbanization is an effective modifier of race/ethnicity’s effect on lupus nephritis mortality, suggesting neighborhood environmental factors [into] health outcomes,” he said.
Abatacept & RA Prevention
Dr. Juergen Rech
Abatacept improved subclinical inflammation in patients at risk of developing RA, with longer-term results awaited, according to findings presented by Juergen Rech, MD, a rheumatologist and researcher at the University Clinic Erlangen, Germany.4
The therapy targets the window of opportunity when patients experience arthralgias and have signs of subclinical inflammation, but don’t yet have any current or previous signs of swelling, don’t have a diagnosis of clinical arthritis and haven’t received glucocorticoids or treatment with disease-modifying anti-rheumatic drugs (DMARDs).
The study had 49 patients in the abatacept treatment arm, who received treatment for six months, and 49 in a placebo arm. The average patient age was 51 years in the abatacept arm and 49 years in the placebo arm. The study met its primary end point, with 30 patients in the treatment arm achieving significant improvement in magnetic resonance imaging (MRI) inflammation scores—an assessment of synovitis, tenosynovisits and osteitis—compared with 15 patients in the placebo group (P=0.0043).
Only four patients in the abatacept arm progressed to arthritis, compared with 17 in the placebo group (P=0.0025).
“Abatacept is superior to placebo in inhibiting the progression to arthritis at six months,” Dr. Rech said. “Follow-up results at 18 months will reveal whether the effect of a time-limited intervention of abatacept has a sustained effect on inhibition of progression to arthritis.”
Imaging in Cognitive Impairment & SLE
Dr. John Hanly
Patients with SLE and cognitive impairment have abnormalities in brain function detected by resting state functional MRI and enhanced permeability of the blood-brain barrier,5 said John Hanly, MD, professor of medicine and pathology at Dalhousie University, Halifax, Nova Scotia, Canada, adding that the observations may open a new avenue for treatment.
In 78 people with SLE and 71 healthy controls, researchers performed cognitive function tests, as well as neuroimaging with resting state functional MRI and contrast imaging to assess blood-brain-barrier leakage. Forty-seven of the patients with SLE were found to have cognitive impairment in at least one area, including information-processing speed, executive ability—such as multi-tasking—or other categories.
Researchers found the total number of brainwide connections in specific brain regions decreased and the usual functional connectivity between brain regions was altered in patients with SLE and cognitive impairment (P=0.01), as well as in individuals with higher blood-brain barrier permeability (P=0.011).
“Future studies,” Dr. Hanly said, “should investigate the mechanisms underlying blood-brain-barrier-mediated cognitive impairment and the potential of targeting the blood-brain barrier as a therapeutic strategy in SLE patients.”
Thomas Collins is a freelance medical writer based in Florida.
References
- Paley M, Deepak P, Kim W, et al. Immunosuppression attenuates antibody and neutralization titers in patients with chronic inflammatory disease following SARS-CoV-2 vaccination [abstract 0457]. Arthritis Rheumatol. 2021;73(suppl 10).
- Ostor A, Papp K, Moreno M, et al. Efficacy and safety of risankizumab for active psoriatic arthritis: 24-week integrated results from the phase 3, randomized, double-blind KEEPsAKE 1 and 2 trials for csDMARD-IR and bio-IR patients [abstract 0453]. Arthritis Rheumatol. 2021;73(suppl 10).
- Yen E, Rajkumar S, Sharma R, et al. Lupus nephritis mortality in the United States, 1999–2019: Disparities by race/ethnicity and place of residence and a recent worsening trend [abstract 0454]. Arthritis Rheumatol. 2021;73(suppl 10).
- Rech J, Ostergaard M, Tascilar, et al. Abatacept reverses subclinical arthritis in patients with high-risk to develop rheumatoid arthritis—Results from the randomized, placebo-controlled ARIAA study in RA-at risk patients [abstract 0455]. Arthritis Rheumatol. 2021;73(suppl 10).
- Hanly J, Robertson J, Kamintsky L, et al. Functional connectivity, enhanced blood-brain barrier leakage and cognitive impairment in systemic lupus erythematosus [abstract 0456]. Arthritis Rheumatol. 2021;73(suppl 10).
