Historically, rheumatoid arthritis (RA) treatment options were limited to glucocorticoids and conventional synthetic disease-modifying antirheumatic drugs (DMARDs), such as methotrexate. In recent years, biologic DMARDs and small molecule–targeted synthetic DMARDs have become available, which demonstrate comparable or improved efficacy and safety. As the treatment landscape for RA expands, rheumatologists must learn how best to use the available therapeutic tools to achieve and/or maintain remission or low disease activity for patients living with this chronic disease. At the 2019 European Congress of Rheumatology hosted by the European League Against Rheumatism (EULAR), investigators shared results on approved and investigational agents that promise to further advance the science of treating RA.

One phase IIIb/IV study assessed withdrawal vs continued methotrexate in patients receiving the oral JAK inhibitor tofacitinib who had achieved low disease activity with combination therapy (tofacitinib plus methotrexate). Six weeks after randomization, tofacitinib monotherapy (ie, withdrawal from methotrexate) was noninferior to continued combination therapy.

Filgotinib, an investigational oral selective JAK1 inhibitor, demonstrated significant improvements in disease activity when combined with methotrexate, and the combination therapy was well tolerated. Similarly, the JAK1 inhibitor upadacitinib was safe and effective as monotherapy vs methotrexate in patients who had inadequate responses to methotrexate or who were naive to methotrexate. Moreover, a pooled safety analysis demonstrated that the safety profile of upadacitinib is comparable to approved RA therapies.

Fenebrutinib, an investigational, oral BTK inhibitor, led to significant improvement vs placebo when administered in combination with methotrexate in patients with an inadequate response to previous RA therapy.

Many other advances were reported at EULAR 2019, including long-term safety data on the approved JAK inhibitor baricitinib in patients with RA. Detailed reporting of key data from the conference is available from multiple educational sources, such as Clinical Care Options’ Conference Coverage.