imaging findings available. The researchers
randomised 160 patients to either treat-to-
target or usual care management by the
centre they attended to prevent cross con-
tamination of management strategies. The
treat-to-target regimen involved office ex-
aminations and consultations every 4 weeks
rather than every 3 months with usual care,
and also required a predefined management
strategy with treatment prompts based on
the strategy sent to the treating clinicians
via the electronic medical record. The
average age of the patients was 38 years,
they had been diagnosed with axSpA for
an average of just under 4 years, and their
mean ASDAS score at entry was 3. During
the 12 months of management, 56% of
the patients in the treat-to-target arm
initiated treatment with a bDMARD, com-
pared with 28% among the controls. Use
of NSAIDs was similar between the two
TICOSPA was sponsored by UCB. Dr.
Moltó has been a consultant to and received research funding from AbbVie, Bristol-Myers Squibb, Merck, Pfizer, and UCB.Prof. Dougados has had financial relationships with AbbVie, Bristol-Myers Squibb,Janssen, Lilly, Novartis, Merck, Pfizer, andUCB. Prof. van der Heijde has had financialrelationships with more than 20 companies including UCB. Dr. Ramiro had been aconsultant to or received research fundingfrom AbbVie, Lilly, Merck Sharp & Dohme,Novartis, and Sanofi.
The risk for venous thromboembo- lism (VTE) is almost 50% lower in patients with RA taking tumour ne- crosis factor (TNF) inhibitors than itwas in those taking conventional syntheticdisease-modifying antirheumatic drugs(DMARDs), according to data from theGerman RABBIT registry.
“Some rheumatologists have thought TNFinhibitors could increase the risk for venousthromboembolism events, but we don’tthink this is true, based on our findings,”said investigator Dr. Anja Strangfeld, whopresented the findings at the congress.
The risk is more than one-third lowerin RA patients treated with other newerbiologics, such as abatacept, rituximab,sarilumab, and tocilizumab.
However, risk for a serious venousthromboembolism is twice as high in patients with C-reactive protein (CRP) levelsabove 5 mg/L and is nearly three times ashigh in patients 65 years and older.
For the study, Dr. Strangfeld, of theGerman Rheumatism Research Center inBerlin, and her colleagues followed about
11,000 patients for more than 10 years.
“Patients with RA have a greater risk for
venous thromboembolism compared with
the general population, but we didn’t know
the risk conveyed by different DMARD treat-
ments,” Dr. Strangfeld said in an interview.
“It is also evident that higher age and lower
capacity for physical function increase the
Chronic inflammation in RA patients
elevates the risk for deep vein and pul-
monary thrombosis by two to three times,
said Prof. John Isaacs of Newcastle Uni-
versity in Newcastle Upon Tyne, United
Kingdom, who is chair of the EULAR Sci-
entific Programme Committee.
Among the supporting studies Prof.Isaacs discussed during an online pressconference was a Swedish trial of morethan 46,000 RA patients, which had beenpresented earlier by Viktor Molander, aPhD candidate from the Karolinska Institute in Stockholm (abstract OP0034).
Mr. Molander’s team showed that 1 in100 patients with high disease activity willdevelop venous thromboembolism within ayear, which is twice the number of eventsseen among patients in remission.
Combined with the RABBIT data, bothstudies show that, “if you can control theirdisease in the right way, you’re not onlyhelping rheumatoid arthritis patients feelbetter, but you could be prolonging theirlives,” Prof. Isaacs said.
The prospective RABBIT study followedRA patients who began receiving a newDMARD after treatment failed with at leastone conventional synthetic DMARD, suchas methotrexate or leflunomide. At baseline, those taking TNF inhibitors or otherbiologics had higher CRP levels on average,as well as a higher rate of existing cardiovascular disease. They also received glucocorticoids, such as prednisone, more often.
The observational nature of the RABBIT
study is a weakness, Dr. Strangfeld said, and
it could not prove cause and effect. But the
methodology had several strengths, including
input on patient factors from participating
rheumatologists at least every 6 months.
“We enrolled patients at the start oftreatment and observed them, regardlessof any treatment changes, for up to 10years,” she added. “That’s a really longobservation period.”
The RABBIT data can help shape treatment decisions, said Prof. Loreto Carmonaof the Musculoskeletal Health Institutein Madrid, who is chair of the EULAR Abstract Selection Committee.
For a woman with RA who smokes andtakes oral contraceptives, for example, “ifshe has high levels of inflammation, I thinkit’s okay to use TNF inhibitors, where maybe in the past we wouldn’t have thoughtthat,” she said.
“The TNF inhibitors are actually reduc-
ing the inflammation and, therefore, re-
ducing the risk,” Prof. Carmona said in an
interview. “It could be an effect of using
the drugs on people with higher levels of
inflammation. It’s an indirect protective
The study was funded by a joint uncon-
ditional grant from AbbVie, Amgen, Bris-
tol-Myers Squibb, Fresenius-Kabi, Hexal,
Lilly, Merck Sharp & Dohme, Mylan, Pfizer,
Roche, Samsung Bioepis, Sanofi-Aventis,
and UCB. Dr. Strangfeld is on the speakers
bureaus of AbbVie, Bristol-Myers Squibb,
Pfizer, Roche and Sanofi-Aventis. Prof.
Isaacs is a consultant or has received
honoraria or grants from AbbVie, Amgen,
Merck, Pfizer, Roche, and UCB. Prof. Car-
mona has disclosed no relevant financial
TNF inhibitors cut odds of VTE in RA patients
DR. STRANGFELD PROF. CARMONA
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