Highlights from ACR 2021

Highlights from ACR 2021

The American Congress of Rheumatology (ACR) again took place virtually, but the exchange on new findings was lively as usual in the SpA community. ASIF’s Scientific Advisor, Uta Kiltz attended the congress and provides an insight into the sessions through her personal highlights.

The assessment of treatment response in axSpA patients relies heavily on the assessment of pain. Therefore, the question of how concomitant fibromyalgia symptoms affect patient reported outcomes is relevant. Baraliakos et al. have now investigated this question and published their results as a poster. The main finding is that clinical symptoms in axSpA and fibromyalgia partially overlap and that response pattern of PROs is not different between axSpA and fibromyalgia. However, so-called composite scores such as the ASDAS discriminate between axSpA and fibromyalgia. Consequently, the assessment of disease activity by the ASDAS has long been recommended by the international expert association ASAS

The influence of patient and disease characteristics on global functioning and health in patients with AxSpA is incompletely understood. In the early axSpA cohort DESIR, this analysis has now been performed based on the ASAS Health Index. In this so-called Bayesian network analysis, global functioning was shown to be influenced by disease activity and physical functioning as well as comorbidities, but largely independent of structural damage in the spine. The consequence of these study results is that the process of coping needs to be better understood in order to better understand these apparent adaptive processes.

In patients who are in remission with TNFi therapy, the question of whether the therapy could not be reduced repeatedly arises in clinical practice. A previous study with adalimumab suggested that this may be possible in some patients. However, the Ability 3 study only examined patients who received either adalimumab or placebo. The C-OPTIMISE study presented at the ACR examined continuation/reduction/ discontinuation Certolizumab Pegol. Only patients who were in remission from prior therapy with certolizumab pegol were randomised. Patients continuously treated with CZP benefit from this treatment. The study showed that neither treatment discontinuation nor dose reduction produced similarly good results as continuing the approved dose.

The development of bimekizumab, a monoclonal bispecific selective interleukin 17A and 17F inhibitor, is advanced in the study program. Bimekizumab shows sustained and clinically meaningful long-term improvements in health-related quality of life in patients with ankylosing spondylitis. Interim results after 3 years of treatment have been presented at the ACR with good results. Bimekizumab is already approved in the EU for skin psoriasis.

At ACR, initial results were presented on a new mode of action using an oral, selective MK2 inhibitor with sustained multi-cytokine inhibition for the treatment of ankylosing spondylitis. Results of the Phase I study were presented with promising results and the information was shared that the Phase II study for patients with AS has been initiated.

Assessment and monitoring of disease activity and function is of great importance for qualified treatment of patients with axSpA. Tight control strategies are beneficial in patient care, but are also time and personnel intensive. Strict monitoring enables timely effective adjustment of therapy. However, due to lack of time and staff, intensive treatment plans are often not feasible, even though they are superior to conventional approaches. Health apps are increasingly used to record Patient Reported Outcomes (PRO). To date, however, good data for this strategy in axSpA patients are lacking. The aim of a study presented by R. Kempin was to collect data on the practicality and adherence of a commercial health app. The app could be used by most patients, but adherence was poor over the course of six months. Interestingly, older patients had higher adherence, as did patients with high disease activity. The authors conclude that a digital app is feasible for axSpA patients with high disease activity in order to direct them to more rapid therapy initiation.

Thank you to Uta for this informative summary