Rheum in Review: Medication, Mobility, and Mental Health Connections

Here are the top stories covered by DocWire News this week in the Rheumatology section. In this edition, learn about cardiovascular indications (or lack thereof) in two medications, the relationship between osteoarthritis and hypermobility, the connection between anti-inflammatories and depression, and the latest update for chronic obstructive pulmonary disease patients with rheumatoid arthritis.

According to new research featured in JAMA Dermatology, patients taking ustekinumab (STELARA) for psoriasis or psoriatic arthritis do not have any greater risk for atrial fibrillation (AF) or major adverse cardiovascular events (MACE) than those being treated with tumor necrosis factor inhibitors (TNFi). Among 60,028 psoriasis and psoriatic arthritis patients, 9,071 were ustekinumab initiators and 50,957 were TNFi initiators. The overall crude AF incidence rate (reported per 1,000 person-years) for ustekinumab initiators was 5.0 (95% CI, 3.8-6.5), and for TNFi initiators was 4.7 (95% CI, 4.2-5.2); for MACE, the rates were 6.2 (95% CI, 4.9-7.8) and 6.1 (95% CI, 5.5-6.7), respectively. When using TNFi initiators as the reference group, the combined adjusted hazard ratio among ustekinumab initiators for incident AF was 1.08 (95% CI, 0.76-1.54), and for MACE was 1.10 (95% CI, 0.80-1.52). The researchers hope this information will be beneficial when weighing the risks and benefits of various treatment options.

Meanwhile, a newly approved osteoporosis drug has been given a boxed warning for possible increased risk of heart attack, stroke, and cardiovascular death by the Food and Drug Administration. Romosozumab-aqqg (EVENITY) is indicated for postmenopausal women with osteoporosis who have a high risk for fracture. In one of two clinical trials testing the drug, an increased risk was observed for cardiovascular death, heart attack, and stroke. Romosozumab-aqqg is therefore not indicated for patients who have had a heart attack or stroke within the previous year. Amgen, EVENITY’s manufacturer, also announced that a monthly dose will cost $1,825, or $21,900 for a year’s supply.

A recent review published in Acta Psychiatrica Scandinavica found evidence suggesting that anti-inflammatory medications—those used to treat arthritis—could benefit patients with depression. The researchers reviewed 36 randomized controlled trials (RCTs) that discussed antidepressant treatment effects and side effects of pharmacological anti-inflammatory intervention among patients with depression or depression symptoms. Depression patients saw improvement in their symptoms when taking anti-inflammatory agents as an add-on (standardized mean difference [SMD] = −0.64; 95%‐CI = −0.88, −0.40; I2 = 51%; n = 597) or monotherapy (SMD = −0.41; 95%‐CI = −0.60, −0.22; I2 = 93%, n = 8825); anti-inflammatory as an add-on treatment also resulted in improved response (risk ratio [RR] = 1.76; 95%‐CI = 1.44–2.16; I2 = 16%; n = 341) and remission (RR = 2.14; 95%‐CI = 1.03–4.48; I2 = 57%; n = 270). There may be an increased risk of infection, the researchers added, noting that the studies also had high bias risk.

New rheumatoid arthritis (RA) research featured in Seminars in Arthritis and Rheumatism contradicted a previous trial: in the latest study, RA patients with chronic obstructive pulmonary disease (COPD) did not have increased odds of adverse events (AEs) when taking abatacept. In the new database review, researchers compared abatacept initiators (n = 1,807) to biologic disease-modifying antirheumatic drug (bDMARD) initiators (n = 3,547) for the following endpoints: Endpoints included hospitalized COPD exacerbation, bronchitis, and hospitalized pneumonia or influenza. Overall, the combined endpoint of all outcomes’ hazard ratio (HR) was 0.87 (95% CI: 0.68–1.12); upon individual analysis, the HR for hospitalized COPD exacerbation was 0.60 (95% CI: 0.32–1.11); for bronchitis, it was 0.80 (95% CI: 0.56–1.14). For hospitalized pneumonia or influenza it was 1.39 (95% CI: 0.91–2.13); for outpatient, it was 1.05 (95% CI: 0.86–1.29). The findings contradict those of the 2006 ASSURE trial, which the current researchers note had a smaller patient population. In the ASSURE trial, of 54 COPD patients, 37 received abatacept and the rest (n = 17) received placebo; AE rates were 97.3% and 88.2%, respectively. Abatacept patients had a significantly higher respiratory complication rate compared to placebo patients (43.2% versus 23.5%).

Researchers reported in BMC Musculoskeletal Disorders that there is no correlation between joint hypermobility and multiple joint osteoarthritis (MJOA). Four definitions were used for MJOA. Of the 1,677 total patients (mean age, 69 years; 68% female), 3.9% filled the joint hypermobility criteria, and 63% met any MJOA definition. There was a correlation between one MJOA-defined subset (involvement of ≥ 1 interphalangeal nodes and ≥ 2 sites [one site indicates one joint] including hip, knee, and spine) and hypermobility, but no connection when considering the other three MJOA parameters, which were: involvement of ≥ 2 IP joints, ≥ 1 carpometacarpal (CMC) joints, and knee or hip sites; involvement of ≥ 5 joint sites from among distal interphalangeal, proximal interphalangeal, CMC, hip, knee, or spine sites; and involvement of ≥ 2 lower body sites (hip, knee, or spine).