Noninvasive vagus nerve stimulation is worthy of further exploration as a potential treatment in RA.
Next Steps
Dr. Marsal notes that the next step in research on this subject would be to further validate the results from this study by conducting properly controlled, randomized clinical trials. Dr. Baker and Dr. Genovese indicate the company that produces the device will be directing a sham-controlled study in the U.S.
Much remains to be learned about the neurologic/immunologic connection in RA, and this study helped shed some light on the subject and provide evidence that noninvasive vagus nerve stimulation is worthy of further exploration as a potential treatment in RA.
Researchers will be able to help advance the field of rheumatology by rigorously evaluating novel treatments like vagus nerve stimulation and—as long as they have the nerve to do so—can help many patients in the process.
Jason Liebowitz, MD, completed his fellowship in rheumatology at Johns Hopkins University, Baltimore, where he also earned his medical degree. He is currently in practice with Skylands Medical Group, N.J.
References
- Adlan AM, Lip GYH, Paton JFR, et al. Autonomic function and rheumatoid arthritis: A systematic review. Semin Arthritis Rheum. 2014 Dec;44(3):283–304.
- Pavlov VA, Tracey KJ. Neural regulation of immunity: Molecular mechanisms and clinical translation. Nat Neurosci. 2017 Feb;20(2):156–166.
- Evrengül H, Dursunoglu D, Cobankara V, et al. Heart rate variability in patients with rheumatoid arthritis. Rheumatol Int. 2004 Jul;24(4):198–202.
- Koopman FA, Chavan SS, Miljko S, et al. Vagus nerve stimulation inhibits cytokine production and attenuates disease severity in rheumatoid arthritis. Proc Natl Acad Sci U S A. 2016 Jul 19;113(29):8284–8289.
- Genovese MC, Gaylis N, Sikes D, et al. Safety and efficacy of neurostimulation with a miniaturised vagus nerve stimulation device in patients with multidrug-refractory rheumatoid arthritis: A two-stage multicentre, randomised pilot study. Lancet Rheumatol. 2020 Sept 1;2(9):E527–538.
- Marsal S, Corominas H, de Agustín JJ, et al. Non-invasive vagus nerve stimulation for rheumatoid arthritis: A proof-of-concept study. Lancet Rheumatol. 2021 Apr 1;3(4):e262–269.
- Drewes AM, Brock C, Rasmussen SE, et al. Short-term transcutaneous non-invasive vagus nerve stimulation may reduce disease activity and pro-inflammatory cytokines in rheumatoid arthritis: Results of a pilot study. Scand J Rheumatol. 2021 Jan;50(1):20–27.
