Rheumatology

After first TNFi failure in RA, upadacitinib outperforms adalimumab at 12 weeks

SELECT-SWITCH randomized 492 RA patients with inadequate response or intolerance to one non-adalimumab TNFi, all on stable methotrexate. At week 12, DAS28-CRP ≤3.2 occurred more often with upadacitinib than adalimumab (43.3% vs 22.4%; absolute difference 21.0%). Upadacitinib also yielded higher ACR50 responses, more DAS28-CRP <2.6, and greater improvements in DAS28-CRP and pain than adalimumab. HAQ-DI changes and overall safety were similar, supporting mechanism switch to JAK inhibition rather than TNFi cycling after first TNFi failure. 1

RA-ILD: non-rituximab b/tsDMARDs show comparable respiratory outcomes, with mortality advantages for abatacept and JAK inhibitors

This Medicare-based target trial emulation propensity-matched RA-ILD initiators of abatacept, JAK inhibitors, IL-6 inhibitors, or TNFi to rituximab users. For the composite of respiratory hospitalization, lung transplant, or death, hazard ratios versus rituximab were close to 1 and not statistically different. Abatacept and JAK inhibitors were associated with lower mortality than rituximab in secondary analyses, while IL-6 inhibitors and TNFi were not. These findings support considering abatacept or JAK inhibitors as reasonable alternatives to rituximab in RA-ILD, pending randomized trials. 2

Low-dose oral glucocorticoids for ICI arthritis did not worsen cancer progression-free survival

This RADIOS registry study analyzed 269 patients with immune checkpoint inhibitor–associated inflammatory arthritis, mostly with stage IV cancer. Median glucocorticoid dose in the first treatment month was 13 mg/day prednisone equivalent; few received early DMARDs. Time-varying Cox models showed no significant association between glucocorticoid exposure and progression-free survival, with wide confidence intervals. Higher versus lower initial glucocorticoid doses were also not linked to worse progression-free survival, supporting cautious use of low-dose steroids. 3