Sessions include Ranjeny Thomas’ update on immunotherapies, Peter Wong on osteoporosis refracture prevention and Eric Morand on anifrolumab in lupus.
Australia’s researchers didn’t miss a beat at the 2023 EULAR congress.
Here are some of the highlights from the first three days.
Antigen-specific induction of immunotolerance
Professor Ranjeny Thomas, Brisbane
Key takeaway: “We are at a stage where antigen-specific immunotherapies are developed, they’re progressing through clinical trials, and we are starting to understand the mechanisms and the biomarkers of their response.”
Presenting at the Friday morning session on immunotolerance, Professor Ranjeny Thomas gave an update on her work in antigen-specific immunotherapies.
“I think the best opportunity in rheumatic diseases is for immunotherapy in people with remission and with the aim to extend remission and potentially get people off drugs,” she told Rheumatology Republic.
While the end goal – a vaccine for rheumatoid arthritis – is still firmly in the distance, the building blocks and mechanisms for immunotherapies are beginning to become clear.
“It’s a huge step forward, because five or 10 years ago we really didn’t have any of the building blocks,” Professor Thomas said.
“But with the development of drugs that could deliver antigen-specific immunotherapy, it’s allowed us to build the markers of response.”
Her recent research has focussed on DEN-181 (Rheumavax, Dendright Pty Ltd), a vaccine candidate composed of autologous modified dendritic cells and four citrullinated peptide antigens encased in liposomes.
Professor Thomas was involved in a small double-blind, single-ascending-dose phase 1 trial of the vaccine in a methotrexate-stable patient group.
Relative to the placebo, patients who received a medium or high dose of DEN-181 displayed a decrease in Cit-Vim-specific T cells, and an increase in the percentage of CII-specific programmed cell death 1+ T cells.
“Interestingly, we saw a reduction in output V domain glycosylation, which is associated with the onset of rheumatoid arthritis,” she said.
“We saw a decrease in the low dose relative to the high dose.”
After investigating various features and correlations, Professor Thomas and her team came to the conclusion that the best opportunities to prolong remission with immunotherapy is to target people who are already in remission.
“Treat-to-target is a good strategy because it gets people into remission and we should aim to keep people there and monitor them,” she said.
“Because I think as a disease becomes longer and longer standing, it’s going to be harder and harder to achieve that.”
Session: A journey around immunotolerance
Osteoporosis re-fracture prevention
Associate Professor Peter Wong
Key takeaway: “Everyone after a fracture needs some sort of bone health assessment, and it’s everyone’s job – it’s the GP’s job, it’s the nurse’s job, it’s the physio’s job and it’s the rheumatologist’s job.
Speaking at the Friday oral abstract session on osteoporosis, NSW-based rheumatologist Associate Professor Peter Wong presented on the impact of a specialised fracture follow up service which identified patients with osteoporosis at risk of re-fracture.
The two study sites were Coffs Harbour and Port Macquarie.
An osteoporosis refracture prevention program was set up in Coffs Harbour in 2012, and Port Macquarie received its own service in 2018.
“Following the establishment of the … service in Coffs Harbour in 2012/13, there was a fall in fracture related … episodes of care,” Professor Wong told EULAR delegates.
The reduction was roughly 10%, which he admitted was somewhat disappointing.
In 2019, the NSW government announced a mandate that all hospitals with a fracture clinic had to introduce an osteoporosis refracture program.
“A 10% [reduction] is not great, but I would say it’s better than nothing,” he said.
“And so what we want to shift to now is [finding out] how robust that data is for the whole of New South Wales.”
Professor Wong told Rheumatology Republic that he was enthusiastic about the statewide program, and that the next step would be to introduce more community-based refracture programs.
“Osteoporosis refracture services are [typically] hospital-based, but there’s a lot that happens in the community that we also need to be part of, because this is a chronic disease,” he said.
Anifrolumab for lupus – the TULIP long-term extension
Professor Eric Morand
Key takeaway: “During the four-year TULIP long-term extension combined period, treatment with anifrolumab 300 milligram in patients who originally started with moderately to severely active disease resulted in earlier attainment of low disease activity, greater cumulative time with low disease activity and a greater likelihood of sustained periods of low disease activity.”
Monash University researcher Professor Eric Morand was a prolific presenter at EULAR 2023, appearing on the speaker program no less than eight times.
During one of the first oral abstract sessions on Wednesday, Professor Morand gave an update on results from the long-term TULIP anifrolumab study.
The TULIP cohort consists of patients with active systemic lupus erythematosus across 123 sites in 18 countries.
The original study ran for one year, and a long-term extension ran for a further three years.
Professor Morand presented results from 369 patients, of which about 70% received anifrolumab 300mg and 30% received placebo.
At the 12-month mark, 40% of patients in the anifrolumab group had achieved lupus low disease activity state, compared to 28% of the placebo group.
By the end of the long-term extension, 37% of the anifrolumab group had low disease activity compared to 17% of the placebo patients.
“Over the total four years, we can see that the separation between the anifrolumab and placebo groups persisted, with more patients in low disease activity in the anifrolumab treated arm compared to the placebo treated arm,” Professor Morand told delegates.
“Across years two, three and four, cumulative time in low disease activity therefore also favoured anifrolumab, with a cumulative time in months of 14 for anifrolumab versus 8.7 for placebo.”
EULAR 2023 was held at the MiCo Convention Centre in Milan, Italy, between 31 May and 3 June.
