24 February 2021

What to expect in 2021

COVID-19 Events Medications

We take a look at new rheumatology drugs on the horizon, some exciting new initiatives and the calendar for major events in 2021. But right now, all attention is fixed on the COVID-19 vaccine rollout.

At-risk groups are being prioritised in the rollout strategy, though health experts are keeping an eye on trial results and safety data from vaccination programs under way elsewhere.

“A key question is how well vaccines that show protection in young, healthy individuals will work in people who have chronic medical conditions or are immunocompromised,” wrote a group of infectious disease and immunisation experts, including National Centre for Immunisation Research and Surveillance (NCIRS) director, Peter McIntyre, in a December report for NPS MedicineWise.

Mona Marabani, a rheumatologist at Canterbury Hospital in southwest Sydney, said clinicians must encourage all of their patients to be vaccinated, with whichever available vaccine is offered and regardless of their patients’ current therapy.

“There’s no reason that our rheumatology patients shouldn’t be vaccinated,” Dr Marabani told Rheumatology Republic.

“None of these vaccines are ‘live’ vaccines so even those patients on biologics or other DMARDs, it’s safe for them to be vaccinated,” Dr Marabani said.

Dr Marabani added that extra care might be needed for patients on rituximab, to time their vaccination according to when they received their last rituximab infusion.

“We know that being on an agent like rituximab can blunt your response to vaccination, but even if it does so, we’d still recommend vaccinating those patients,” she said.

Helping to prepare patients for the vaccine rollout, the ARA issued a factsheet in mid-January about COVID-19 vaccinations, and the American College of Rheumatology has release updated guidance too.

Even with the scheduled vaccine rollout, virtual meetings will probably still be the way to go for a while yet – just hopefully without the tech headaches seen last year.

A few drugs might also be made available in Australia in 2021, giving patients more treatment options.

The oral JAK inhibitor upadacitinib, which is already PBS-listed for severe RA, is tabled for the next PBAC meeting in March where it will be considered for the treatment of severe PsA and ankylosing spondylitis.

Filgotinib, an advanced drug candidate from pharmaceutical giant, Gilead, will also be assessed at the same PBAC meeting.

Even though Gilead recently abandoned their pursuit of FDA approval of filgotinib for RA in the US, the company appears to be continuing to seek regulatory approval of filgotinib in Australia for patients with severe active RA.

Also set to launch in 2021 are four TGA-approved Humira biosimilars, but conversations continue about ways to encourage uptake of these near-perfect substitutes for adalimumab.

“There’s a constant need for more education and awareness about biosimilars to raise patients’ comfort levels and cognisance of these therapies, to allay their fears and to demystifying what are otherwise medicines that we already know a lot about,” Seth Ginsberg, director of patient advocacy group Creaky Joints, told Rheumatology Republic.

With more treatment options also comes questions about which drugs work best for which patients, and when.

Pandemic aside, Dr Marabani said the growing presence of JAK inhibitors in the treatment landscape is a hot topic for rheumatologists who want to know where these drugs fit in the treatment pathway.

Here, the recently launched Australian Arthritis and Autoimmune Biobank Collaborative (A3BC) could provide some insights in years to come. In 2021, A3BC will be working to gather momentum amongst clinicians who are keen to involve their patients in this nationwide initiative, led by University of Sydney’s Professor Lyn March.

As for clinical trials, here’s hoping trials delayed by the pandemic are soon resumed and the impressive flexibility of clinical trial testing necessitated by COVID-19 lives on to accelerate clinical research.

“The rapid clinical trial programs brought about by the pandemic have shown how it’s possible to do these things differently, to accelerate trials, and not to compromise good clinical practice and safety protocols,” Dr Marabani said.

Meanwhile, other research programs continue steady as planned.

A randomised, placebo-controlled trial testing a stem cell therapy for people with knee OA has recently begun recruiting the first of its 440 patients at two sites, in Sydney and Hobart.

Years in the making, the trial has been met with enthusiasm by rheumatologists and stem cell experts alike.

And it just goes to show how even with the pandemic – that will undoubtedly shape the year ahead like it did the last – rheumatologists are steadily working to improve outcomes for their patients.

2021 conferences

The major rheumatology conferences for 2021 are a mix of virtual and hybrid (virtual and in-person) events. They include: