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Lana Pine is the editor of HCPLive Rheumatology. She is an experienced editor and technical writer with a demonstrated history of working in the banking and publishing industries. In her free time, she enjoys cooking, yoga, listening to podcasts, and drawing. She can be reached via email at LPine@mjhlifesciences.com.

A post hoc analysis of the phase 3 KEEPsAKE 1 and KEEPsAKE 2 trials evaluating risankizumab treatment in patients with 

 showed greater efficacy when compared with placebo, according to research published in 

“Recent guidelines (Group for Research and Assessment of Psoriasis and Psoriatic Arthritis, the European League Against Rheumatism, and the American College of Rheumatology/National Psoriasis Foundation) endorse a specialized treatment approach for patients with PsA and other underlying comorbidities,” wrote a team of investigators led by Joseph Merola, MD, MMSc, associated with the Department of Dermatology at Brigham and Women’s Hospital, Harvard Medical School. “However, an unmet need remains for new treatment options that provide durable efficacy in a variety of patients, across heterogeneous patient demographics and clinical characteristics.”

Although advancements in PsA have led to the development of a number of treatments for this patient population, those with other comorbidities or prior exposure to biologic therapies could experience lower levels of efficacy.

Risankizumab, a fully humanized immunoglobulin G1 monoclonal antibody that specifically inhibits interleukin (IL)-23 by binding to the p19 subunit, has been proven to be an effective treatment for PsA. This analysis determined long-term efficacy of the drug among clinically relevant subgroups stratified by age, sex, race, body mass index, and disease characteristics up to 52 weeks.

The study focused on the proportion of patients who were able to achieve ≥ 20%/50%/70% improvement in the American College of Rheumatology response criteria (ACR20/50/70), minimal disease activity status, low disease activity status, minimal clinically important difference in pain, and ≥ 90% improvement in the Psoriasis Area and Severity Index (PASI) at week 24 and week 52 compared with baseline demographics and clinical characteristics.

Eligible patients were aged ≥ 18 years, had a clinically confirmed PsA diagnosis, and an inadequate response or intolerance to biologic therapies and/or conventional synthetic disease-modifying antirheumatic drugs (csDMARDs).

In both trials, patients were randomized 1:1 to receive subcutaneous risankizumab 150 mg or placebo at weeks 0, 4, and 16. At week 24, those in the placebo group were switched to risankizumab 150 mg and those in the risankizumab cohort received a single, double-blinded dose of placebo. At week 28, all patients were treated with risankizumab every 12 weeks for up to 52 weeks.

Within the sample, baseline characteristics and demographics were comparable among patients receiving risankizumab (n = 707) and placebo (n = 700). Approximately half (47.8% — 55.4%) were female, the mean age ranged from 51.2 to 53.1 years, the mean PASI scores were 7.7 to 10.9, and the mean body mass index scores ranged from 30.3 to 31.5.

At week 24, numerically higher ACR20 response rates were reported in the risankizumab cohort (46.3% — 60.1%) compared with the placebo cohort (15.5% — 36.2%), regardless of subgroup categorization.

At the 52-week mark, consistent proportions of patients randomized to risankizumab were able to achieve ACR20 (48.6% — 75.8%). Additionally, those initially treated with placebo who were then switched to risankizumab reported a similar improvement from week 24 (43.7% — 63.9%), regardless of subgrouping.

These trends were also noted among other efficacy measures, including those evaluating skin response criteria, composite measures of overall disease activity, and PsA-related symptoms. Treatment with risankizumab was shown to be an effective strategy among patients with PsA regardless of varying demographic and psoriatic disease characteristics through 1 year.

Investigators noted the relatively small sample size among a few subgroups as a limitation of the study, which may have led to more imprecise estimates of treatment effects. They encourage future research to examine real-world patient data to confirm if results are generalizable to the general population.

“These efficacy results support long-term use of risankizumab for patients with active PsA across multiple patient and psoriatic disease characteristics,” investigators concluded.

Merola JF, Armstrong A, Khattri S, et al. Efficacy of risankizumab across subgroups in patients with active psoriatic arthritis: a post hoc integrated analysis of the phase 3 KEEPsAKE 1 and KEEPsAKE 2 randomized controlled trials. 

. 2024;35(1):2342383. doi:10.1080/09546634.2024.2342383

Kumthekar A, Ogdie A. Obesity and psoriatic arthritis: a narrative review. Rheumatol Ther. 2020;

):447–−456. doi:10.1007/s40744-020-00215-6.

Articles

Treatment with risankizumab was shown to be an effective strategy among patients with PsA regardless of varying demographic and psoriatic disease characteristics through 1 year. 

News

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Psoriatic Arthritis

On the HCPLive psoriatic arthritis page, resources on the topics of medical news and expert insight into PsA can be found. Content includes articles, interviews, videos, podcasts, and breaking news on arthritis, and more.

Long-term Risankizumab Treatment Outperforms Placebo in PsA 

Connor Iapoce is an associate editor for 

 and joined the MJH Life Sciences team in April 2021. He graduated from The College of New Jersey with a degree in Journalism and Professional Writing. He enjoys listening to records, going to concerts, and playing with his cat Squish. You can reach him at 

Thoracic ultrasound (TUS) combined with systematic screening for pre-defined respiratory symptoms may reduce the diagnostic delay in detecting 

rheumatoid arthritis-association interstitial lung disease (RA-ILD)

In the analysis, TUS examination accurately detected 82.6% of ILD cases, suggesting its applicability as a screening method to determine the need for further diagnostic workup for ILD, such as a chest high-resolution computed tomography (HRCT).

“Early identification of ILD should minimize the time of disease manifestation to treatment and, thereby, reduce the disease burden and treatment necessary to manage the lung disease and improve quality of life and overall survival,” wrote the investigative team, led by Bjørk K. Sofíudóttir, MD, department of rheumatology, Odense University Hospital.

A severe manifestation of RA, RA-ILD is present in approximately 2-10% of the patient population and demonstrates a 5-year mortality risk of 40%, compared with matched controls.

 As a result, patients with RA are recommended to receive a diagnostic workup for ILD, with a chest HRCT and multi-disciplinary team (MDT) discussion considered the gold standard.

However, although patients with RA are prone to lung diseases, including chronic obstructive pulmonary disease (COPD), there are no guidelines to screen for respiratory symptoms in RA.

 TUS has shown promising results in RA and other ILD populations, but it has not been validated as a screening method for undiagnosed RA-ILD.

The throrAcic UltRasOund in RA (AURORA) study was a prospective cross-sectional diagnostic test accuracy study with patient enrollment from June 2022 to May 2023.

 Sofíudóttir and colleagues sought to determine the diagnostic accuracy of TUS in detecting ILD in RA patients with respiratory symptoms using chest HRCT combined with MDT.

Eligible patients were adults diagnosed with RA, assessed by an experienced rheumatologist, and presenting with respiratory symptoms, including dyspnea, cough, recurrent pneumonia, prior severe pneumonia, or a chest X-ray indicating interstitial abnormalities. A respiratory disease diagnosis other than ILD excluded a patient from the study, as did an HRCT in the previous 12 months.

TUS positive criteria included B-lines must be present in ≥2 zones with ≥10 B-lines in total or thickened and fragmented pleura in a minimum of 1 zone bilaterally. HRCT, the imaging reference standard for diagnosing ILD, was performed within 30 days after TUS. The sensitivity and specificity of TUS, comprising its positive predictive value (PPV) and negative predictive value, were the analysis’ primary outcomes.

Study participants were consecutively enrolled in outpatient clinics in rheumatology departments in four different hospitals in Southern Denmark. Ultimately, 80 participants with a positive screening were consecutively included in the study, of whom 77 received HRCT <30 days after TUS. A total of 23 (30%) participants were diagnosed with ILD, and TUS indicated ILD in 45 (58%) participants.

Upon analysis, TUS exhibited a sensitivity of 82.6% (95% CI, 61.2 - 95.0) and a specificity of 51.9% (95% CI, 37.8 - 65.7), with a diagnostic odds ratio (OR) of 5.12 (95% CI, 1.5 to 17.0). These results corresponded to a PPV of 42.2% (95% CI, 27.7 - 57.8) and an NPV of 87.5% (95% CI, 71.0 - 96.5).

Sofíudóttir and colleagues noted the increasing mortality rates in RA-ILD may be due to both the unawareness of the condition, as well as a delay in ILD diagnostics, often at late and severe stages of the lung disease. Evidence-based screening for the early initiation of diagnostics may be warranted to treat RA-ILD at earlier stages, including TUS.

“Using HRCT combined with MDT as a reference test for ILD, this study has validated TUS as a radiation-free bedside tool for triaging RA patients with respiratory symptoms for HRCT, with an NPV of 87.5%,” they wrote.

Sofíudóttir BK, Harders S, Laursen CB, et al. Detection of Interstitial Lung Disease in Rheumatoid Arthritis by Thoracic Ultrasound. A Diagnostic Test Accuracy study. Arthritis Care Res (Hoboken). Published online April 15, 2024. doi:10.1002/acr.25351

Hyldgaard C, Hilberg O, Pedersen AB, Ulrichsen SP, Lokke A, Bendstrup E, et al. A population-based cohort study of rheumatoid arthritis-associated interstitial lung disease: comorbidity and mortality. Ann Rheum Dis. 2017;76(10):1700-6.

Lynch DA, Sverzellati N, Travis WD, Brown KK, Colby TV, Galvin JR, et al. Diagnostic criteria for idiopathic pulmonary fibrosis: a Fleischner Society White Paper. Lancet Respir Med. 2018;6(2):138-53.4

Hyldgaard C, Ellingsen T, Bendstrup E. COPD: an overlooked cause of excess mortality in patients with rheumatoid arthritis. Lancet Respir Med. 2018.

Thoracic ultrasound examination may be applicable as a screening method for interstitial lung disease in patients with RA and respiratory symptoms.

Rheumatoid Arthritis

The HCPLive rheumatoid arthritis page is a comprehensive resource for clinical news and insights on arthritis. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for RA, and more.

Pulmonology

Infectious Disease condition center page is a comprehensive resource for clinical news and insights on respiratory health. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for asthma, COPD, interstitial lung disease, COVID-19, and more.

Thoracic Ultrasound Refines Detection of ILD in Rheumatoid Arthritis

Results of a retrospective analysis showed only half of patients with 

 who discontinued treatment with pegloticase and initiated another urate lowering therapy (ULT) were able to achieve target serum urate (SU), according to research published in 

Investigators believe close follow-up could help to optimize the outcomes of treatment post-pegloticase.

Although gout is commonly treated with ULT, some patients are unable to tolerate oral ULTs. In these cases, pegloticase, a US Food and Drug Administration (FDA)-approved recombinant pegylated uricase, is often prescribed to treat this patient population. However, discontinuation of this treatment is commonly necessary in cases in which loss of treatment efficacy is observed or in patients who develop anti-drug antibodies (ADAs).

“The optimal gout treatment after pegloticase discontinuation has not yet been established, and little is known about long-term SU management following discontinuation,” wrote a team of investigators led by Emily E Holladay, MPH, Program Manager II in the Division of Clinical Immunology & Rheumatology at the University of Alabama at Birmingham. “Additionally, more information is needed on how or if pegloticase influences renal function and systemic inflammation. Renal impairment is common in gout patients, and gout increases the risk of chronic kidney disease (CKD). This association is further complicated as CKD can limit the use of both oral ULTs and gout flare treatments.”

To better understand optimal treatment practices in patients with gout who discontinued pegloticase, investigators performed a retrospective analysis using data from the Rheumatology Informatics System for Effectiveness (RISE) registry between January 2016 and June 2022. Discontinuation was defined as a gap of ≥ 12 weeks post infusion. ULT use, inflammatory biomarkers, renal function, and SU were evaluated after pegloticase discontinuation.

Outcomes were assessed starting 2 weeks after the last dose and the team identified new ULT therapies. Changes in laboratory tests, such as SU, C-reactive protein (CRP), estimated glomerular filtration rate (eGFR), and erythrocyte sedimentation rate (ESR), were compared during treatment and after discontinuation.

A total of 375 patients with gout discontinuing pegloticase were included in the analysis. The mean age of patients was 60.3 years, most (82.9%) were male, 62.7% were White, and 76.8% had tophi.

Post-discontinuation, median laboratory changes were SU: +2.4 mg/dL (0.0 — 6.3); CRP: -0.8 mg/L (-12.8 — 0.0); eGFR: -1.9 mL/min (− 8.7 — 3.7); and ESR: -4.0 mm/hr (-13.0 — 0.0).

The most common therapy following pegloticase was an oral ULT (86.0%), while 4.5% of patients restarted treatment with pegloticase and 9.5% of patients did not report receiving any ULT. Among the oral ULTs documented, 62.7% received allopurinol and 34.1% received febuxostat.

The median time to starting or restarting ULT treatment was 92.0 days (55.0 — 173.0).

After being prescribed another ULT for ≥ 30 days, only 51.0% of patients were able to achieve SU < 6 mg/dL. Those who restarted treatment with pegloticase were able to obtain a median SU of 0.9 mg/dL and 58.3% of these patients reported SU levels of < 6 mg/dL.

Investigators mentioned the strengths of the study included the large sample size using real-world data to determine patient outcomes post-pegloticase. However, the study was limited by a significant portion of missing laboratory information. Additionally, SU measurement timing following discontinuation varied among the cohort, which may have impacted the interpretation of the full response to oral ULTs. Further, results may not be generalizable to patients treated in academic and subspecialty clinics as RISE data is mainly collected from community rheumatology practices. Lastly, the reasons for treatment discontinuation were not accounted for.

“Given that pegloticase is most-often used in patients refractory to oral ULT, this finding is important,” investigators concluded. “This study offers some of the first insight on post-pegloticase gout management, but further study is needed to determine optimal treatment regimens and the possible use of pegloticase re-treatment.”

Holladay EE, Mudano AS, Xie F, et al. Urate-lowering therapy, serum urate, inflammatory biomarkers, and renal function in patients with gout following pegloticase discontinuation. 

. 2024;26(1):86. Published 2024 Apr 12. doi:10.1186/s13075-024-03318-5

Guttmann A, Krasnokutsky S, Pillinger MH, Berhanu A. Pegloticase in gout treatment - safety issues, latest evidence and clinical considerations. Ther Adv Drug Saf. 2017;8(12):379–88.

After being prescribed another urate lowering therapy for ≥ 30 days, only 51.0% of patients were able to achieve SU < 6 mg/dL. 

Gout

On the HCPLive gout page, resources on the topics of medical news and expert insight into gouty arthritis can be found. Content includes articles, interviews, videos, podcasts, and breaking news on gout, and more.

Only Half of Patients Starting ULT After Pegloticase Discontinuation Achieved Target SU

Tim Smith joined the MJH Life Sciences team as an assistant editor for HCPLive in August 2022. He graduated from UC Berkeley with a degree in political science, working in multimedia journalism as a staff writer prior to joining MJH. In his spare time, he enjoys reading, watching TV, listening to podcasts, and rock climbing. You can contact him at 

A discussion of a website used to assess digital applications for patients struggling with mental health issues.

Patrick Hemming, MD: Which Mental Health App is Best for Internal Medicine Patients?

In this interview discussion, Patrick Hemming, MD, discussed some of the additional takeaways from his 

American College of Physicians (ACP) Internal Medicine Meeting

 presentation ‘Depression and Anxiety Treatment by the Internal Medicine Physician,’ touching on a useful website for internists.

Hemming works as an associate professor and as director of resident education for the Duke Outpatient Clinic at Duke University’s department of medicine. In his prior interview segments, Hemming had detailed utilizing the 

 for internal medicine patients with depression.

In this segment, Hemming was specifically asked about the website 

 and its use for internists looking to help direct patients to mental health-related smartphone applications.

“People are always interested in new technology in every part of medicine,” he explained. “I got some help from the Beth Israel Deaconess Medical Center here in Boston, as they have a division of digital psychiatry and Dr. John Torous met with me to go over some of these things. They study this and have developed a really nice online resource…It's a non-industry supported clearinghouse and a search mechanism for people who are looking for app-based health particularly in the mental health sphere.”

Hemming explained that this website may help patients to determine which app could work best for them, given the wide variety of potential apps designed for mental health needs.

“There are over 10,000 apps that do mental health stuff, so there's no shortage of things that are marketing themselves,” Hemming said. “But this website actually evaluates them for things like the cost, the interface, how usable it is, and the privacy settings. So if you're sharing sensitive stuff about yourself with a company, how is that being used? Things like that.”

Hemming noted that most individuals do not continue to use apps longterm, with many downloading them, using them a couple of times, and often forgetting about them.

“As patients ask us about this, my approach is, essentially, that there are some things that we don't have the time to teach patients or coach them through,” he said. “Things like deep breathing exercises, things like mindfulness or meditation, things like setting up new habits. The vast majority of these mental health apps do that and at least 40 or 50% of them are free.”

To learn more about the contents of Hemming’s interview, view the full segment posted above. The website referenced by Hemming is https://mindapps.org/Apps.

The quotes contained in this summary were edited for the purposes of clarity. Hemming has no relationships with entities whose primary business is marketing, selling, producing, re-selling, or distributing healthcare products used by or on patients.

Videos

This segment of Hemming’s ACP interview featured a discussion of a website used to assess digital applications for patients struggling with mental health issues.


Internal Medicine

Internal Medicine condition center page, resources on the topics of medical news and expert insight into internal medicine can be found. Content includes articles, interviews, videos, podcasts, and breaking news on internal medicine research, treatment, and drug development.

Psychiatry

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Patrick Campbell is the managing editor of HCPLive. Formerly the editorial lead of Endocrinology Network, Practical Cardiology, and Rheumatology Network, Patrick has spent years spearheading coverage surrounding cardiometabolic health and rheumatic disease for MJH Life Sciences. He now helps to lead coverage in each of these respective areas for HCPLive. Before joining MJH Life Sciences in 2019, he spent time as a beat reporter with the Pocono Record in Stroudsburg, PA, and Star News Group in Manasquan, NJ. He also touts experience in multimedia, having spent time as a multimedia specialist with NJ Advance Media and multimedia coordinator at the Pocono Record. Follow him on Twitter @RealPatCampbell or reach him via email at PCampbell@mjhlifesciences.com.

In recent years, few topics have attracted the same level of attention in cardiovascular medicine, particularly among lipidogists, as the evolving recognition of lipoprotein(a) [Lp(a)] as a marker of elevated risk. This evolving recognition of risk is happening in tandem with a growing knowledge base and burgeoning therapeutic pipeline. 

In 2019, the National Lipid Association released a scientific statement on using Lp(a) in clinical practice. Fast-forward a half-decade to April 01, 2024, and the NLA has released an update to this statement further clarifying recommendations surrounding the use of Lp(a) in clinical practice. A 12-page document citing more than 80 references, the recommendations and insights are the subject of a 3-part clinical quiz series from HCPLive Cardiology. 

The first of the series, this quiz focuses on the basics surrounding the testing of Lp(a) in clinical practice. 

Immunochemical assay calibrated against WHO/IFCCLM reference material

Koschinsky ML, Bajaj A, Boffa MB, et al. A focused update to the 2019 NLA scientific statement on use of lipoprotein(a) in clinical practice. 

. Published online March 29, 2024. doi:10.1016/j.jacl.2024.03.001

Editor's note: This quiz was composed with the assistance of artificial intelligence tools. 

The first in our 3-part quiz series based on the NLA's 2024 update to their 2019 scientific statement on use of lipoprotein(a) in clinical practice focuses on basic considerations surrounding Lp(a) measurement.

Dyslipidemia

Clinical Quiz: Lp(a) Testing Basics from 2024 NLA Update on Use of Lipoprotein(a)

A new study found female patients (8.15%) had a lower mortality rate when treated by female physicians than male physicians (8.38%).

Patients Have Lower Mortality When Treated by Female Physicians

Abeona's pz-cel is up for indicated use to treat patients with recessive dystrophic epidermolysis bullosa.

FDA News

Dermatology

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Rare Disease Report®

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FDA Issues CRL to Abeona for Potential RDEB Cell Therapy

Rilzabrutinib led to a durable platelet response in adult patients with persistent or chronic immune thrombocytopenia in the LUNA 3 study. 

Hematology

Rilzabrutinib Achieves Phase 3 Primary Endpoint in Immune Thrombocytopenia

Experts discuss the use of biosimilars in treating neovascular age-related macular edema (nAMD) and diabetic macular edema (DME).

Ophthalmology

Ophthalmology page, resources on the topics of medical news and expert insight into ophthalmic disease can be found. Content includes articles, interviews, videos, podcasts, and breaking news on eye disease research, treatment, and drug development.

The Impact of Biosimilars in Retinal Diseases

Abigail Brooks is an assistant editor for 

She joined MJH Life Sciences in August 2023 shortly after graduating from Monmouth University where she earned her BA in Communication with a concentration in Public Relations/Journalism and later an MA in Interactive Digital Media. She enjoys traveling, running, and reading books. She can be reached at abrooks@mjhlifesciences.com.

Branch provides an overview of the use of dual antiplatelet therapy and anticoagulants based on his session at the ACP Internal Medicine meeting.

Cardiology

Cardiology condition center page is a comprehensive resource for clinical news and insights on cardiovascular and cardiometabolic diseases. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for heart disease and cardiovascular events, as well as associated diabetes, renal failure, and more...

Kelley Branch, MD: Considerations for Dual Antiplatelet Therapy, Anticoagulation

Experts discuss the safety of aflibercept 8 mg, emphasizing familiarity, efficacy, and durability, supported by reassuring data from the two-year PULSAR and PHOTON studies. 

Safety Considerations for New Therapies

Another segment of her ACP 2024 interview featured a discussion on weight loss drugs, healthy living, and discussions with patients.


Anne Thorndike, MD, MPH: Discussing Obesity, Physical Activity, Weight Loss Drugs

NBI-1065845 shows promise in alleviating symptoms of major depressive disorder in patients with inadequate response to current antidepressant treatments, according to phase 2 SAVITRI study data.

Major Depressive Disorder

Major Depressive Disorder condition center page, resources on the topics of medical news and expert insight into depression can be found. Content includes articles, interviews, videos, podcasts, and breaking news on MDD research, treatment, and drug development.

Phase 2 SAVITRI Supports Use of NBI-1065845 in Major Depressive Disorder with Inadequate Response to Antidepressants

A new study found the perceived onset of old age rose nearly 3 years from 1911 to 1953.

Geriatrics

Geriatric medicine condition center page is a comprehensive resource for clinical news and insights on frequent geriatric-related diseases and conditions. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for sleep disorder, dementia, Alzheimer's disease, and more.

Middle Age and Older Adults Perceive “Old Age” Begins Later Than a Decade Ago

Shah discusses the prevalence of psychiatric illness among hospitalized patients and highlights key considerations for their management from her session at ACP.

Latest News

Long-term Risankizumab Treatment Outperforms Placebo in PsA

Thoracic Ultrasound Refines Detection of ILD in Rheumatoid Arthritis

Only Half of Patients Starting ULT After Pegloticase Discontinuation Achieved Target SU

Patrick Hemming, MD: Which Mental Health App is Best for Internal Medicine Patients?

Clinical Quiz: Lp(a) Testing Basics from 2024 NLA Update on Use of Lipoprotein(a)