Rheumatology

Many routine RA patients are RCT-ineligible but have similar adjusted remission.

In a registry of 5462 RA patients initiating b/tsDMARDs, 39.7% met at least one common phase III exclusion criterion. Unadjusted ineligible patients had worse baseline disease activity and function than eligible patients. After propensity weighting, 26-week CDAI remission was similar between ineligible and eligible patients (24.0% vs 23.2%; OR 0.90, 95% CI 0.78–1.04). Between-drug differences were smaller in the RCT-ineligible cohort; JAK inhibitor advantage seen in eligible patients was attenuated and non-significant in ineligible patients. 1

Nintedanib plus dual immunosuppression associated with stable lung function in SSc-ILD.

A pooled multicentre cohort of 64 ILD patients (36 SSc-ILD, 28 RA-ILD) evaluated triple therapy with nintedanib plus two immunomodulators. In 35 SSc-ILD patients with longitudinal data, FVC and DLCO remained stable at 6 and 12 months while mRSS fell by 2.1 points at 12 months (95% CI -3.5 to -0.7). Serious adverse events occurred in 3 patients (4.7%) and infections in 5 (7.8%); 75% of patients continued therapy after nintedanib dose reduction. Authors conclude triple therapy was generally tolerable and support prospective studies to confirm effectiveness and safety. 2

JDM remission common but long-term outcomes vary by demographics and delays.

Systematic review of 42 studies (6194 children) found remission rates varying widely (PRINTO-based 21.6–73.0%) and persistent disease in 11–12% by PROM/PRINTO criteria. Calcinosis was reported in 10–40% and mortality clustered in the acute phase from pulmonary or infectious causes. Poorer long-term outcomes associated with younger age at onset, African ancestry, socioeconomic disadvantage, diagnostic delay, and higher baseline skin or muscle involvement. Authors recommend early diagnosis, timely treatment, and use of validated outcome measures to improve prognosis. 3