The annual meeting of the American College of Rheumatology (ACR) kicked offvirtuallyThursday,bringing together scientists, medical doctors,patientsand othersinvolved in the rheumatology field from around the globe. It will continue for five days withscientificsessionsby some of the leading minds in the arena.
COVID-19 Treatments and Vaccines
The opening session included alectureabout inflammationand COVID-19by Eric Rubin,MD,PhD, editorin chief of theNew England Journal of Medicineandchair of HarvardUniversity’s T.H. Chan School ofPublic Health Department of Immunology and Infectious Diseases.Dr. Rubindiscussedstudiesonthe use of different anti-inflammatory drugs—many of them used to treat rheumatic diseases—作为COVID-19的潜在治疗方法。Results so far have been conflictingand nothing has emerged as a clear winner, but the studies have helpedrevealthat certain drugs may be more effectiveat certainstagesof COVID-19andat certain levels of disease severity.
Dr. Rubin alsodescribed the various types of vaccinesand thesignificant challenges todevelopingsafe, effective vaccines. The processtypically takes yearsandlarge numbers oftrial participants, andwhilea number ofCOVID-19 vaccines are in the works, hedidn’t speculate as to when they would be safe and effective.He did say, however, that he believesmany of thevaccines will be inactivated,meaning they will be safe for immunosuppressed people, but itisn’tclear how effective they will be.
With other types of vaccines,studies also have found thatvaccinatedpeopledon’thavethe same decline in immunity over time compared with those who achieve immunity from contracting the disease. He expects the same to be true with a future COVID-19 vaccine.
2020Review
Another highlight of the opening session wasa look at 2020’s rheumatologynewsmakersinclinical science,presented byJinoosYazdhany, MD, professor of medicine and rheumatology atthe University of California at San Francisco.Her top choices:
- Positive news for lupus.A studyfoundthe druganifrolumab(which has not yet been approved by the Food and Drug Administration, FDA)effective formoderate or severely active lupus,excluding severe renaland central nervous system involvement. Another found thatbelimumab may be a good option for lupus nephritis.What’smore, Dr.Yazdhanysays,anifrolumabappears to be effective for skin lesions,andtrial participantstaking it were able to reduce theirglucocorticoid(steroid)doses.
- Better information on dosing and safety ofglucocorticoids.Several studiesshowed thatcertain vasculitis and rheumatoid arthritis (RA) patients can safely taper their steroid dose (with guidance from their doctor).In addition,even low dosesof these steroidsin some RA patients may increase the risk of hospitalization infection.
- More evidenceabout tapering drugs.While remission remains a goal for many patients and physicians,one studythis yearfound thatreducing the dose of ananti-tumor necrosis factor(TNF) biologic did not increase flares inparticipantswithearlyaxial spondylitis. Andrituximab reducesvasculitisflares in some people over the long-term.
- More information about drug safety.A very large recent study foundlong-term (five years or more) use of bisphosphonates, used to treat osteoporosis,increases the risk ofunusual fracturesofthe femur(although still rare).Stopping the drug dramatically drops the risk.However,fractureswere found to occur more often in women of Asian descent.The upshot,says Dr.Yazdhany: Drug holidays should be recommended for all patients taking these drugs, especially forAsianAmericanwomen.From astudyof methotrexateinpeople withcardiovasculardisease,Dr.Yazdhanyextrapolated severalside effects, includinga “newsafety signal regarding skin cancer.”In a largestudy of colchicine(commonly used to treat gout)inpatients with chronic coronary disease,“10% had to drop out,mostly for GI side effects,” she says.“Only 9 outof 10 patients could tolerate colchicine.”However,it did appear to reduceheart attacksandstroke.
- New drugs forspondyloarthritis(SpA).Studies have found drugs that use different pathways, or mechanisms,areeffective fortheseconditions, providing more options for patients.Guselkumab, an interleukin-23 (IL-23) inhibitor,was effective for psoriatic arthritis patients who had not had adequate response toother therapies. Anda newJanus kinase (JAK) inhibitoris showing promise foraxial-SpA, which could give those patients a pill option.
- Rheumatology drugs as potential COVID-19 treatments.Dexamethasone reduced mortalityin patients onventilators, buthad nobenefit for patients who were notventilatedand “maybe a hint of harm” for those not receiving oxygen.Lots of studies have been done on hydroxychloroquinein COVID-19patients as a preventative,Dr.Yazdhanysays, and“every single one of them wascategoricallynegative,demonstrating that this drug has no role for the treatment of COVID-19.”The studies also found that even in high doses, hydroxychloroquinerarely leads to cardiac death.Other drugs also are being investigated, but more information is needed abouthow each affectswhichgroup ofpatients, becausethere’sa lot of variability, she says.The only drug shown to reduce mortality so far is dexamethasone, andthat’sonly in certain patients.Referring to aU.K. study of numerous therapies for hospitalized patients, she says,“I think this trial beautifully demonstrates that COVID-19 is not just one disease and that immunosuppressant medications might have a greater role in the later, hyper-inflammatory phases of the disease.”—JILL TYRER