New treatment options for scleroderma and RA patients non-responsive to biologics, a systematic review of fibromyalgia treatment options and the science of empathy.
New treatment options for scleroderma and RA patients non-responsive to biologics, a systematic review of fibromyalgia treatment options and the science of empathy.
Novel biologic shows promise in scleroderma trial
The anti-interleukin agent romilkimab has shown significant benefits on skin fibrosis among patients with systemic sclerosis in a 24-week phase II trial involving 97 patients.
Romilkimab acts on IL-4 and IL-13, which recent studies have suggested play a prominent role in the immune dysregulation seen in systemic sclerosis.
The trial design allowed for background immunosuppressive therapy, and by adding experimental treatment to standard of care therapy reflected real-world conditions.
The primary efficacy endpoint was the change from baseline at week 24 in the modified Rodnan skin score. Patients taking background immunosuppressives tended to do better than those who weren’t, as did patients with higher Rodnan skin scores.
With few treatment options for systemic sclerosis, the positive results of this study suggest a phase III trial is warranted.
Ann Rheum Dis 2020, 22 September
JAKi vs abatacept for RA
A recent head-to-head trial of oral JAK inhibitor upadacitinib and T-cell co-stimulation modulator abatacept in patients with moderate-to-severe RA found upadacitinib had superior efficacy but more adverse events.
The 24-week, double-blind phase III trial involved 612 patients who’d previously had an inadequate response to biologic DMARDs. They were randomly assigned to daily 15 mg oral upadacitinib or intravenous abatacept, with stable background medications permitted.
The primary end point was the change from baseline in the composite Disease Activity Score for 28 joints based on the C-reactive protein level (DAS28-CRP), where upadacitinib demonstrated non-inferiority at week 12. There were more serious adverse events in the upadacitinib group, as well as infections and hepatic abnormalities.
The authors noted that longer-term data from larger studies are required to fully determine the safety and efficacy of upadacitinib.
The study was sponsored by AbbVie.
Few treatment options for fibromyalgia
What therapies can help reduce pain and improve quality of life in patients with fibromyalgia? A systematic review and meta-analysis has found little support for the effectiveness of most therapies. Researchers in Australia and Brazil reviewed over 200 published randomised or quasi-randomised clinical trials involving almost 30,000 patients.
There was strong evidence for cognitive-behavioural therapy for pain reduction, and antidepressants and central nervous system depressants for pain reduction and improved quality of life, but while statistically significant, the effects were small and unlikely to be clinically important to patients. There was also a lack of long-term evidence for the interventions.
The researchers concluded, “Clinicians should be aware that current evidence for most of the available therapies for the management of fibromyalgia is limited to small trials of low methodological quality.”
JAMA Intern Med. 2020, 26 October
The science of empathy
Could empathy help patients achieve treatment goals?
American rheumatologist Dr Leonard Calabrese presented a talk on ‘the science of empathy’ at ACR Convergence. Dr Calabrese framed empathy as a cognitive rather than emotional attribute, which involved an understanding of experiences, concerns and perspective of the patient, combined with a capacity to communicate this understanding back to the patient and an intention to help. Importantly, it can be taught.
Empathic communication is vital to patient satisfaction, he argued, and provided plenty of practical tips. Empathy is also integral in helping close the gap between providers’ and patients’ goals. Furthermore, empathic providers have greater job satisfaction and less burnout. Win-win.
Watch the presentation here.
