Findings from a proof-of-concept trial provide preliminary evidence to suggest that the JAK inhibitor baricitinib is well tolerated and may have efficacy for the treatment of relapsing giant cell arteritis.

A monthly selection of topical peer-reviewed articles from the Adis journals, curated by the editors.

How can rheumatologists respond to the challenges associated with rituximab use during the pandemic?

Findings from a systematic review and meta-analysis indicate that patients treated with anti-CD20 therapies have a heterogeneous response to vaccines against SARS-CoV-2, with particularly low seroconversion rates among those with recent B-cell depletion.

Presenting the findings in a late-breaking poster session at the conference, Liew noted that “the majority of fully vaccinated individuals with breakthrough infections were on anti-metabolites or B-cell depleting therapies,” with 18% taking CD20 inhibitors and 28% glucocorticoids.

They also note that responders had significantly higher numbers of unswitched memory B cells at baseline than nonresponders, suggesting that nonresponders “might have been on the higher end of the disease severity spectrum.”

Since ianalumab is a fully human monoclonal antibody blocking B-cell activating factor receptor, that is additionally engineered for direct ADCC-mediated B-cell depletion, Bowman and team measured median time to CD19+ B-cell recovery after stopping treatment and found that this was generally dose proportional.

In their review article, Sarzi-Puttini and colleagues explain that the generation of protective antibodies against SARS-CoV-2 will likely be attenuated as a result of rituximab-induced B cell depletion, suggesting that interrupting rituximab treatment may permit effective vaccination against COVID-19.

But the phase 3 BLISS-LN  and AURORA 1  trials “helped change the treatment landscape of lupus nephritis,” she added, leading the US FDA to approve both the B-cell activating factor (BAFF) inhibitor belimumab  and the calcineurin inhibitor voclosporin  as add-on treatment options in 2021.

3–9 November: Keep up with the latest news and interviews from the conference.

Perspective on the approval of anifrolumab and the importance of endpoints in lupus trials.

A comparison of different treatments for rheumatoid arthritis suggests that Janus kinase inhibitors are associated with the highest risk for herpes zoster, while some biologic DMARDs may also be linked to an increased risk.

Regarding B-cell-targeting biologic agents, rituximab may be used for refractory lupus nephritis patients in combination with another DMARD, and belimumab was recently approved by the US Food and Drug Administration for cSLE treatment in children aged > 5 years.

This difference was mainly driven by a seroconversion rate of just 47% among the 15 patients receiving methotrexate monotherapy and was higher in those receiving tumor necrosis factor (TNF) inhibitors (79% of 24), interleukin (IL)-23 inhibitors (83% of 23) and IL-17 inhibitors (100% of 15).

5 – 9 November: Preview the conference with session recommendations and updates on upcoming coverage.

Study findings from the COVID-19 Global Rheumatology Alliance suggest that rheumatoid arthritis patients taking rituximab or JAK inhibitors are more likely to experience poor outcomes following SARS-CoV-2 infection than those taking TNF inhibitors.

How will the FAST trial results impact regulatory guidance & clinical practice?

Findings from the R4RA trial suggest that tocilizumab may be a more appropriate second-line biologic choice than rituximab for rheumatoid arthritis patients with a low or absent B-cell expression signature based on synovial tissue RNA sequencing.

Experts discuss the increasing use of telemedicine in rheumatology during the COVID-19 pandemic.