Rheumatology

Guselkumab does not improve glucocorticoid-free remission in giant cell arteritis

In this phase 2 randomized placebo-controlled trial, guselkumab did not increase glucocorticoid (GC)-free remission at week 28 versus placebo in giant cell arteritis (40% vs 33%, P=.64). Rates of GCA flare or discontinuation due to worsening disease were similar between guselkumab and placebo through week 28. Time to first flare and overall adverse event rates, including COVID-19 infection and headache, were also comparable between groups. These results do not support guselkumab, an IL-23p19 inhibitor, for treatment of new-onset or relapsing GCA despite concurrent GC tapering. 1

EULAR/ACR criteria beat rheumatologist gestalt for RA risk in clinically suspect arthralgia

Among 501 patients with clinically suspect arthralgia, rheumatologists’ baseline risk estimates modestly discriminated 1-year RA development (AUC 0.64). Clinicians systematically overestimated RA progression risk compared with observed 1-year incidence. The EULAR/ACR risk stratification criteria applied to the same patients showed excellent discrimination (AUC 0.91). These data support using formal criteria, not gestalt alone, when RA risk estimates influence early DMARD decisions or patient counseling. 2

Early belimumab in active SLE is cost-saving and more effective over 15 years

A Markov model of 1000 biologic-naive adults with active SLE compared early (≤2 years disease duration) versus delayed belimumab initiation over 15 years. Early belimumab yielded higher quality-adjusted life-years, with an incremental gain of 0.30 QALYs versus delayed use. Early initiation was associated with substantially lower total direct medical costs, with an incremental cost of -$126,337 per patient. The resulting ICER was strongly dominant (negative), and early treatment was preferred in most probabilistic simulations at conventional willingness-to-pay thresholds. These findings suggest payers and clinicians should reconsider reserving belimumab solely for refractory SLE. 3

Bispecific T cell engagers show rescue potential in refractory antisynthetase syndrome and systemic sclerosis

This compassionate-use series treated five antisynthetase syndrome and five systemic sclerosis patients with bispecific T cell engagers blinatumomab and teclistamab, respectively. Both agents depleted target B-lineage cells in affected tissues and reduced disease-specific autoantibody titers. Blinatumomab led to rapid clinical, serologic, and histologic myositis improvement and stabilized interstitial lung disease in antisynthetase syndrome. Teclistamab improved skin fibrosis, stabilized ILD, and resolved tendon friction rubs in systemic sclerosis. Maintenance rituximab appeared to prolong disease control, but treatment commonly caused cytokine release syndrome and infections, underscoring need for specialized monitoring. 4