New cases of COVID-19 in children in the United States fell slightly, but even that small dip was enough to reverse 2 straight weeks of increases, according to a report from the American Academy of Pediatrics and the Children’s Hospital Association.

New cases totaled 63,862 for the latest reporting week, March 26 to April 1, compared with 64,029 for the previous week, the AAP and the CHA said in their weekly COVID-19 report. For the week ending April 1, children represented 18.1% of all new cases reported in the United States, down from a pandemic-high 19.1% the week before.

COVID-19 cases in children now total just under 3.47 million, which works out to 13.4% of reported cases for all ages and 4,610 cases per 100,000 children since the beginning of the pandemic, the AAP and the CHA said based on data from 49 states (excluding New York), the District of Columbia, New York City, Puerto Rico, and Guam.

Among those jurisdictions, Vermont has the highest proportion of its cases occurring in children at 21.0%, and North Dakota has the highest cumulative rate at 8,958 cases per 100,000 children. Looking at those states from the bottoms of their respective lists are Florida, where children aged 0-14 years represent 8.4% of all cases, and Hawaii, with 1,133 cases per 100,000 children aged 0-17 years, the AAP/CHA report shows.

The data on more serious illness show that Minnesota has the highest proportion of hospitalizations occurring in children at 3.1%, while New York City has the highest hospitalization rate among infected children, 2.0%. Among the other 23 states reporting on such admissions, children make up only 1.3% of hospitalizations in Florida and in New Hampshire, which also has the lowest hospitalization rate at 0.1%, the AAP and CHA said.

Five more deaths were reported in children during the week ending April 1, bringing the total to 284 in the 43 states, along with New York City, Puerto Rico, and Guam, that are sharing age-distribution data on mortality.

[email protected]

New cases of COVID-19 in children in the United States fell slightly, but even that small dip was enough to reverse 2 straight weeks of increases, according to a report from the American Academy of Pediatrics and the Children’s Hospital Association.

New cases totaled 63,862 for the latest reporting week, March 26 to April 1, compared with 64,029 for the previous week, the AAP and the CHA said in their weekly COVID-19 report. For the week ending April 1, children represented 18.1% of all new cases reported in the United States, down from a pandemic-high 19.1% the week before.

COVID-19 cases in children now total just under 3.47 million, which works out to 13.4% of reported cases for all ages and 4,610 cases per 100,000 children since the beginning of the pandemic, the AAP and the CHA said based on data from 49 states (excluding New York), the District of Columbia, New York City, Puerto Rico, and Guam.

Among those jurisdictions, Vermont has the highest proportion of its cases occurring in children at 21.0%, and North Dakota has the highest cumulative rate at 8,958 cases per 100,000 children. Looking at those states from the bottoms of their respective lists are Florida, where children aged 0-14 years represent 8.4% of all cases, and Hawaii, with 1,133 cases per 100,000 children aged 0-17 years, the AAP/CHA report shows.

The data on more serious illness show that Minnesota has the highest proportion of hospitalizations occurring in children at 3.1%, while New York City has the highest hospitalization rate among infected children, 2.0%. Among the other 23 states reporting on such admissions, children make up only 1.3% of hospitalizations in Florida and in New Hampshire, which also has the lowest hospitalization rate at 0.1%, the AAP and CHA said.

Five more deaths were reported in children during the week ending April 1, bringing the total to 284 in the 43 states, along with New York City, Puerto Rico, and Guam, that are sharing age-distribution data on mortality.

[email protected]

New cases of COVID-19 in children in the United States fell slightly, but even that small dip was enough to reverse 2 straight weeks of increases, according to a report from the American Academy of Pediatrics and the Children’s Hospital Association.

New cases totaled 63,862 for the latest reporting week, March 26 to April 1, compared with 64,029 for the previous week, the AAP and the CHA said in their weekly COVID-19 report. For the week ending April 1, children represented 18.1% of all new cases reported in the United States, down from a pandemic-high 19.1% the week before.

COVID-19 cases in children now total just under 3.47 million, which works out to 13.4% of reported cases for all ages and 4,610 cases per 100,000 children since the beginning of the pandemic, the AAP and the CHA said based on data from 49 states (excluding New York), the District of Columbia, New York City, Puerto Rico, and Guam.

Among those jurisdictions, Vermont has the highest proportion of its cases occurring in children at 21.0%, and North Dakota has the highest cumulative rate at 8,958 cases per 100,000 children. Looking at those states from the bottoms of their respective lists are Florida, where children aged 0-14 years represent 8.4% of all cases, and Hawaii, with 1,133 cases per 100,000 children aged 0-17 years, the AAP/CHA report shows.

The data on more serious illness show that Minnesota has the highest proportion of hospitalizations occurring in children at 3.1%, while New York City has the highest hospitalization rate among infected children, 2.0%. Among the other 23 states reporting on such admissions, children make up only 1.3% of hospitalizations in Florida and in New Hampshire, which also has the lowest hospitalization rate at 0.1%, the AAP and CHA said.

Five more deaths were reported in children during the week ending April 1, bringing the total to 284 in the 43 states, along with New York City, Puerto Rico, and Guam, that are sharing age-distribution data on mortality.

[email protected]

Iguratimod (IGU) is a novel small-molecule synthetic DMARD being studied for RA; its exact mechanism is unknown, but it inhibits NF-kB activation and seems to reduce bone resorption via RANKL and cartilage erosion via matrix metalloproteinases. Currently, it is approved in Japan and China for treatment of RA; initial studies from 2008-2010 showed improved ACR20 rates compared to placebo and comparable rates with methotrexate monotherapy; combination therapy with methotrexate appears to be more effective than either methotrexate or IGU monotherapy. Yoshikawa et al present a small study of 47 patients receiving methotrexate or methotrexate with IGU and show promising results regarding tapering of methotrexate with sustained remission/low disease activity and decrease in ultrasound evidence of synovitis in patients receiving IGU, suggesting that it is a reasonable longer-term option for RA patients. However, the medication is not approved in the US, nor have studies in patients in the US been published, so generalizability in patients outside of Japan and China is uncertain, in addition to concerns related to the small sample size.

In contrast, tocilizumab is an established therapy for RA; Pappas et al present real-world clinical practice data from the Corrona RA registry. Among nearly 1800 RA patients who initiated tocilizumab therapy, the mean durability of response was over 3 years in terms of maintaining minimum clinically important difference (MCID) over baseline CDAI and over 1 year in terms of maintaining low disease activity. Most patients in the study had previously received biologic therapy. Though the observational nature of the study limits its generalizability, the addition of efficacy data to persistence on therapy lend weight to this evidence regarding durability of response to tocilizumab, as the proportion of patients maintaining MCID was >50% at 3 years.

Treatment options are limited for RA patients who have ILD or other pulmonary complications. The fear of causing or exacerbating pulmonary toxicity limits the use of methotrexate, leflunomide, and anti-TNF biologics. Some data support the safety of rituximab and abatacept. A retrospective observational study looked at outcomes in RA patients on rituximab and JAK inhibitors. Reassuringly, respiratory event rates were no different between the two groups though number of patients and trial design prevents wider generalization; it is also unknown whether RA-ILD improves with ritixumab or JAK-inhibition. However, given these results, studying JAK inhibitors in larger prospective studies would be reasonable.

Iguratimod (IGU) is a novel small-molecule synthetic DMARD being studied for RA; its exact mechanism is unknown, but it inhibits NF-kB activation and seems to reduce bone resorption via RANKL and cartilage erosion via matrix metalloproteinases. Currently, it is approved in Japan and China for treatment of RA; initial studies from 2008-2010 showed improved ACR20 rates compared to placebo and comparable rates with methotrexate monotherapy; combination therapy with methotrexate appears to be more effective than either methotrexate or IGU monotherapy. Yoshikawa et al present a small study of 47 patients receiving methotrexate or methotrexate with IGU and show promising results regarding tapering of methotrexate with sustained remission/low disease activity and decrease in ultrasound evidence of synovitis in patients receiving IGU, suggesting that it is a reasonable longer-term option for RA patients. However, the medication is not approved in the US, nor have studies in patients in the US been published, so generalizability in patients outside of Japan and China is uncertain, in addition to concerns related to the small sample size.

In contrast, tocilizumab is an established therapy for RA; Pappas et al present real-world clinical practice data from the Corrona RA registry. Among nearly 1800 RA patients who initiated tocilizumab therapy, the mean durability of response was over 3 years in terms of maintaining minimum clinically important difference (MCID) over baseline CDAI and over 1 year in terms of maintaining low disease activity. Most patients in the study had previously received biologic therapy. Though the observational nature of the study limits its generalizability, the addition of efficacy data to persistence on therapy lend weight to this evidence regarding durability of response to tocilizumab, as the proportion of patients maintaining MCID was >50% at 3 years.

Treatment options are limited for RA patients who have ILD or other pulmonary complications. The fear of causing or exacerbating pulmonary toxicity limits the use of methotrexate, leflunomide, and anti-TNF biologics. Some data support the safety of rituximab and abatacept. A retrospective observational study looked at outcomes in RA patients on rituximab and JAK inhibitors. Reassuringly, respiratory event rates were no different between the two groups though number of patients and trial design prevents wider generalization; it is also unknown whether RA-ILD improves with ritixumab or JAK-inhibition. However, given these results, studying JAK inhibitors in larger prospective studies would be reasonable.

Iguratimod (IGU) is a novel small-molecule synthetic DMARD being studied for RA; its exact mechanism is unknown, but it inhibits NF-kB activation and seems to reduce bone resorption via RANKL and cartilage erosion via matrix metalloproteinases. Currently, it is approved in Japan and China for treatment of RA; initial studies from 2008-2010 showed improved ACR20 rates compared to placebo and comparable rates with methotrexate monotherapy; combination therapy with methotrexate appears to be more effective than either methotrexate or IGU monotherapy. Yoshikawa et al present a small study of 47 patients receiving methotrexate or methotrexate with IGU and show promising results regarding tapering of methotrexate with sustained remission/low disease activity and decrease in ultrasound evidence of synovitis in patients receiving IGU, suggesting that it is a reasonable longer-term option for RA patients. However, the medication is not approved in the US, nor have studies in patients in the US been published, so generalizability in patients outside of Japan and China is uncertain, in addition to concerns related to the small sample size.

In contrast, tocilizumab is an established therapy for RA; Pappas et al present real-world clinical practice data from the Corrona RA registry. Among nearly 1800 RA patients who initiated tocilizumab therapy, the mean durability of response was over 3 years in terms of maintaining minimum clinically important difference (MCID) over baseline CDAI and over 1 year in terms of maintaining low disease activity. Most patients in the study had previously received biologic therapy. Though the observational nature of the study limits its generalizability, the addition of efficacy data to persistence on therapy lend weight to this evidence regarding durability of response to tocilizumab, as the proportion of patients maintaining MCID was >50% at 3 years.

Treatment options are limited for RA patients who have ILD or other pulmonary complications. The fear of causing or exacerbating pulmonary toxicity limits the use of methotrexate, leflunomide, and anti-TNF biologics. Some data support the safety of rituximab and abatacept. A retrospective observational study looked at outcomes in RA patients on rituximab and JAK inhibitors. Reassuringly, respiratory event rates were no different between the two groups though number of patients and trial design prevents wider generalization; it is also unknown whether RA-ILD improves with ritixumab or JAK-inhibition. However, given these results, studying JAK inhibitors in larger prospective studies would be reasonable.

Key clinical point: Considerable proportions of cases with rheumatoid arthritis (RA) are still difficult to treat in real world despite intensive treatment.

Major finding: Among patients with RA, 10.1% were categorized as having difficult-to-treat RA despite being treated intensively. Main reasons for difficulty in treating RA were multidrug resistance (34.1%), comorbidities (9.8%), and socioeconomic reasons (56.1%).

Study details: Data come from an analysis of 1,709 patients with RA who visited Keio University Hospital between 2016 and 2017.

Disclosures: The study did not receive any funding. S Takanashi reported no conflicts of interest. Y Kaneko and T Takeuchi reported receiving grants or speaker fees from various sources.

Source: Takanashi S et al. Rheumatology (Oxford). 2021 Mar 2. doi: 10.1093/rheumatology/keab209.

Key clinical point: Considerable proportions of cases with rheumatoid arthritis (RA) are still difficult to treat in real world despite intensive treatment.

Major finding: Among patients with RA, 10.1% were categorized as having difficult-to-treat RA despite being treated intensively. Main reasons for difficulty in treating RA were multidrug resistance (34.1%), comorbidities (9.8%), and socioeconomic reasons (56.1%).

Study details: Data come from an analysis of 1,709 patients with RA who visited Keio University Hospital between 2016 and 2017.

Disclosures: The study did not receive any funding. S Takanashi reported no conflicts of interest. Y Kaneko and T Takeuchi reported receiving grants or speaker fees from various sources.

Source: Takanashi S et al. Rheumatology (Oxford). 2021 Mar 2. doi: 10.1093/rheumatology/keab209.

Key clinical point: Considerable proportions of cases with rheumatoid arthritis (RA) are still difficult to treat in real world despite intensive treatment.

Major finding: Among patients with RA, 10.1% were categorized as having difficult-to-treat RA despite being treated intensively. Main reasons for difficulty in treating RA were multidrug resistance (34.1%), comorbidities (9.8%), and socioeconomic reasons (56.1%).

Study details: Data come from an analysis of 1,709 patients with RA who visited Keio University Hospital between 2016 and 2017.

Disclosures: The study did not receive any funding. S Takanashi reported no conflicts of interest. Y Kaneko and T Takeuchi reported receiving grants or speaker fees from various sources.

Source: Takanashi S et al. Rheumatology (Oxford). 2021 Mar 2. doi: 10.1093/rheumatology/keab209.

Key clinical point: Low cardiorespiratory fitness (CRF) is an important mediator of increased long-term all-cause mortality among patients with rheumatoid arthritis (RA).

Major finding: Patients with RA having CRF below sex-specific and age-specific median had a 28% excess relative risk of mortality (P = .035), of which 5% was associated with the disease itself and 23% was mediated by direct and indirect effects of low CRF.

Study details: Data come from an analysis of patients with RA (n=348) and controls (n=60,938) who participated in the second and third waves of the longitudinal population-based Trøndelag Health Study.

Disclosures: This project was funded by a grant to MH Liff from the Central Norway Regional Health Authority, allocated via the Liaison Committee for Education, Research and Innovation in Central Norway. All the authors declared no conflicts of interest.

Source: Liff MH et al. RMD Open. 2021 March 8. doi: 10.1136/rmdopen-2020-001545.

Key clinical point: Low cardiorespiratory fitness (CRF) is an important mediator of increased long-term all-cause mortality among patients with rheumatoid arthritis (RA).

Major finding: Patients with RA having CRF below sex-specific and age-specific median had a 28% excess relative risk of mortality (P = .035), of which 5% was associated with the disease itself and 23% was mediated by direct and indirect effects of low CRF.

Study details: Data come from an analysis of patients with RA (n=348) and controls (n=60,938) who participated in the second and third waves of the longitudinal population-based Trøndelag Health Study.

Disclosures: This project was funded by a grant to MH Liff from the Central Norway Regional Health Authority, allocated via the Liaison Committee for Education, Research and Innovation in Central Norway. All the authors declared no conflicts of interest.

Source: Liff MH et al. RMD Open. 2021 March 8. doi: 10.1136/rmdopen-2020-001545.

Key clinical point: Low cardiorespiratory fitness (CRF) is an important mediator of increased long-term all-cause mortality among patients with rheumatoid arthritis (RA).

Major finding: Patients with RA having CRF below sex-specific and age-specific median had a 28% excess relative risk of mortality (P = .035), of which 5% was associated with the disease itself and 23% was mediated by direct and indirect effects of low CRF.

Study details: Data come from an analysis of patients with RA (n=348) and controls (n=60,938) who participated in the second and third waves of the longitudinal population-based Trøndelag Health Study.

Disclosures: This project was funded by a grant to MH Liff from the Central Norway Regional Health Authority, allocated via the Liaison Committee for Education, Research and Innovation in Central Norway. All the authors declared no conflicts of interest.

Source: Liff MH et al. RMD Open. 2021 March 8. doi: 10.1136/rmdopen-2020-001545.

A minimally invasive blood test along with artificial intelligence (AI) may flag early-stage Alzheimer’s disease, raising the prospect of early intervention when effective treatments become available.

In a study, investigators used six AI methodologies, including Deep Learning, to assess blood leukocyte epigenomic biomarkers. They found more than 150 genetic differences among study participants with Alzheimer’s disease in comparison with participants who did not have Alzheimer’s disease.

All of the AI platforms were effective in predicting Alzheimer’s disease. Deep Learning’s assessment of intragenic cytosine-phosphate-guanines (CpGs) had sensitivity and specificity rates of 97%.

“It’s almost as if the leukocytes have become a newspaper to tell us, ‘This is what is going on in the brain,’ “ lead author Ray Bahado-Singh, MD, chair of the department of obstetrics and gynecology, Oakland University, Auburn Hills, Mich., said in a news release.

The researchers noted that the findings, if replicated in future studies, may help in providing Alzheimer’s disease diagnoses “much earlier” in the disease process. “The holy grail is to identify patients in the preclinical stage so effective early interventions, including new medications, can be studied and ultimately used,” Dr. Bahado-Singh said.

“This certainly isn’t the final step in Alzheimer’s research, but I think this represents a significant change in direction,” he told attendees at a press briefing.

The findings were published online March 31 in PLOS ONE.
 

Silver tsunami

The investigators noted that Alzheimer’s disease is often diagnosed when the disease is in its later stages, after irreversible brain damage has occurred. “There is currently no cure for the disease, and the treatment is limited to drugs that attempt to treat symptoms and have little effect on the disease’s progression,” they noted.

Coinvestigator Khaled Imam, MD, director of geriatric medicine for Beaumont Health in Michigan, pointed out that although MRI and lumbar puncture can identify Alzheimer’s disease early on, the processes are expensive and/or invasive.

“Having biomarkers in the blood ... and being able to identify [Alzheimer’s disease] years before symptoms start, hopefully we’d be able to intervene early on in the process of the disease,” Dr. Imam said.

It is estimated that the number of Americans aged 85 and older will triple by 2050. This impending “silver tsunami,” which will come with a commensurate increase in Alzheimer’s disease cases, makes it even more important to be able to diagnose the disease early on, he noted.

The study included 24 individuals with late-onset Alzheimer’s disease (70.8% women; mean age, 83 years); 24 were deemed to be “cognitively healthy” (66.7% women; mean age, 80 years). About 500 ng of genomic DNA was extracted from whole-blood samples from each participant.

The researchers used the Infinium MethylationEPIC BeadChip array, and the samples were then examined for markers of methylation that would “indicate the disease process has started,” they noted.

In addition to Deep Learning, the five other AI platforms were the Support Vector Machine, Generalized Linear Model, Prediction Analysis for Microarrays, Random Forest, and Linear Discriminant Analysis.

These platforms were used to assess leukocyte genome changes. To predict Alzheimer’s disease, the researchers also used Ingenuity Pathway Analysis.
 

Significant “chemical changes”

Results showed that the Alzheimer’s disease group had 152 significantly differentially methylated CpGs in 171 genes in comparison with the non-Alzheimer’s disease group (false discovery rate P value < .05).

As a whole, using intragenic and intergenic/extragenic CpGs, the AI platforms were effective in predicting who had Alzheimer’s disease (area under the curve [AUC], ≥ 0.93). Using intragenic markers, the AUC for Deep Learning was 0.99.

“We looked at close to a million different sites, and we saw some chemical changes that we know are associated with alteration or change in gene function,” Dr. Bahado-Singh said.

Altered genes that were found in the Alzheimer’s disease group included CR1L, CTSV, S1PR1, and LTB4R – all of which “have been previously linked with Alzheimer’s disease and dementia,” the researchers noted. They also found the methylated genes CTSV and PRMT5, both of which have been previously associated with cardiovascular disease.

“A significant strength of our study is the novelty, i.e. the use of blood leukocytes to accurately detect Alzheimer’s disease and also for interrogating the pathogenesis of Alzheimer’s disease,” the investigators wrote.

Dr. Bahado-Singh said that the test let them identify changes in cells in the blood, “giving us a comprehensive account not only of the fact that the brain is being affected by Alzheimer’s disease but it’s telling us what kinds of processes are going on in the brain.

“Normally you don’t have access to the brain. This gives us a simple blood test to get an ongoing reading of the course of events in the brain – and potentially tell us very early on before the onset of symptoms,” he added.
 

Cautiously optimistic

During the question-and-answer session following his presentation at the briefing, Dr. Bahado-Singh reiterated that they are at a very early stage in the research and were not able to make clinical recommendations at this point. However, he added, “There was evidence that DNA methylation change could likely precede the onset of abnormalities in the cells that give rise to the disease.”

Coinvestigator Stewart Graham, PhD, director of Alzheimer’s research at Beaumont Health, added that although the initial study findings led to some excitement for the team, “we have to be very conservative with what we say.”

He noted that the findings need to be replicated in a more diverse population. Still, “we’re excited at the moment and looking forward to seeing what the future results hold,” Dr. Graham said.

Dr. Bahado-Singh said that if larger studies confirm the findings and the test is viable, it would make sense to use it as a screen for individuals older than 65. He noted that because of the aging of the population, “this subset of individuals will constitute a larger and larger fraction of the population globally.”
 

Still early days

Commenting on the findings, Heather Snyder, PhD, vice president of medical and scientific relations at the Alzheimer’s Association, noted that the investigators used an “interesting” diagnostic process.

“It was a unique approach to looking at and trying to understand what might be some of the biological underpinnings and using these tools and technologies to determine if they’re able to differentiate individuals with Alzheimer’s disease” from those without Alzheimer’s disease, said Dr. Snyder, who was not involved with the research.

“Ultimately, we want to know who is at greater risk, who may have some of the changing biology at the earliest time point so that we can intervene to stop the progression of the disease,” she said.

She pointed out that a number of types of biomarker tests are currently under investigation, many of which are measuring different outcomes. “And that’s what we want to see going forward. We want to have as many tools in our toolbox that allow us to accurately diagnose at that earliest time point,” Dr. Snyder said.

“At this point, [the current study] is still pretty early, so it needs to be replicated and then expanded to larger groups to really understand what they may be seeing,” she added.

Dr. Bahado-Singh, Dr. Imam, Dr. Graham, and Dr. Snyder have reported no relevant financial relationships.

A version of this article first appeared on Medscape.com.

A minimally invasive blood test along with artificial intelligence (AI) may flag early-stage Alzheimer’s disease, raising the prospect of early intervention when effective treatments become available.

In a study, investigators used six AI methodologies, including Deep Learning, to assess blood leukocyte epigenomic biomarkers. They found more than 150 genetic differences among study participants with Alzheimer’s disease in comparison with participants who did not have Alzheimer’s disease.

All of the AI platforms were effective in predicting Alzheimer’s disease. Deep Learning’s assessment of intragenic cytosine-phosphate-guanines (CpGs) had sensitivity and specificity rates of 97%.

“It’s almost as if the leukocytes have become a newspaper to tell us, ‘This is what is going on in the brain,’ “ lead author Ray Bahado-Singh, MD, chair of the department of obstetrics and gynecology, Oakland University, Auburn Hills, Mich., said in a news release.

The researchers noted that the findings, if replicated in future studies, may help in providing Alzheimer’s disease diagnoses “much earlier” in the disease process. “The holy grail is to identify patients in the preclinical stage so effective early interventions, including new medications, can be studied and ultimately used,” Dr. Bahado-Singh said.

“This certainly isn’t the final step in Alzheimer’s research, but I think this represents a significant change in direction,” he told attendees at a press briefing.

The findings were published online March 31 in PLOS ONE.
 

Silver tsunami

The investigators noted that Alzheimer’s disease is often diagnosed when the disease is in its later stages, after irreversible brain damage has occurred. “There is currently no cure for the disease, and the treatment is limited to drugs that attempt to treat symptoms and have little effect on the disease’s progression,” they noted.

Coinvestigator Khaled Imam, MD, director of geriatric medicine for Beaumont Health in Michigan, pointed out that although MRI and lumbar puncture can identify Alzheimer’s disease early on, the processes are expensive and/or invasive.

“Having biomarkers in the blood ... and being able to identify [Alzheimer’s disease] years before symptoms start, hopefully we’d be able to intervene early on in the process of the disease,” Dr. Imam said.

It is estimated that the number of Americans aged 85 and older will triple by 2050. This impending “silver tsunami,” which will come with a commensurate increase in Alzheimer’s disease cases, makes it even more important to be able to diagnose the disease early on, he noted.

The study included 24 individuals with late-onset Alzheimer’s disease (70.8% women; mean age, 83 years); 24 were deemed to be “cognitively healthy” (66.7% women; mean age, 80 years). About 500 ng of genomic DNA was extracted from whole-blood samples from each participant.

The researchers used the Infinium MethylationEPIC BeadChip array, and the samples were then examined for markers of methylation that would “indicate the disease process has started,” they noted.

In addition to Deep Learning, the five other AI platforms were the Support Vector Machine, Generalized Linear Model, Prediction Analysis for Microarrays, Random Forest, and Linear Discriminant Analysis.

These platforms were used to assess leukocyte genome changes. To predict Alzheimer’s disease, the researchers also used Ingenuity Pathway Analysis.
 

Significant “chemical changes”

Results showed that the Alzheimer’s disease group had 152 significantly differentially methylated CpGs in 171 genes in comparison with the non-Alzheimer’s disease group (false discovery rate P value < .05).

As a whole, using intragenic and intergenic/extragenic CpGs, the AI platforms were effective in predicting who had Alzheimer’s disease (area under the curve [AUC], ≥ 0.93). Using intragenic markers, the AUC for Deep Learning was 0.99.

“We looked at close to a million different sites, and we saw some chemical changes that we know are associated with alteration or change in gene function,” Dr. Bahado-Singh said.

Altered genes that were found in the Alzheimer’s disease group included CR1L, CTSV, S1PR1, and LTB4R – all of which “have been previously linked with Alzheimer’s disease and dementia,” the researchers noted. They also found the methylated genes CTSV and PRMT5, both of which have been previously associated with cardiovascular disease.

“A significant strength of our study is the novelty, i.e. the use of blood leukocytes to accurately detect Alzheimer’s disease and also for interrogating the pathogenesis of Alzheimer’s disease,” the investigators wrote.

Dr. Bahado-Singh said that the test let them identify changes in cells in the blood, “giving us a comprehensive account not only of the fact that the brain is being affected by Alzheimer’s disease but it’s telling us what kinds of processes are going on in the brain.

“Normally you don’t have access to the brain. This gives us a simple blood test to get an ongoing reading of the course of events in the brain – and potentially tell us very early on before the onset of symptoms,” he added.
 

Cautiously optimistic

During the question-and-answer session following his presentation at the briefing, Dr. Bahado-Singh reiterated that they are at a very early stage in the research and were not able to make clinical recommendations at this point. However, he added, “There was evidence that DNA methylation change could likely precede the onset of abnormalities in the cells that give rise to the disease.”

Coinvestigator Stewart Graham, PhD, director of Alzheimer’s research at Beaumont Health, added that although the initial study findings led to some excitement for the team, “we have to be very conservative with what we say.”

He noted that the findings need to be replicated in a more diverse population. Still, “we’re excited at the moment and looking forward to seeing what the future results hold,” Dr. Graham said.

Dr. Bahado-Singh said that if larger studies confirm the findings and the test is viable, it would make sense to use it as a screen for individuals older than 65. He noted that because of the aging of the population, “this subset of individuals will constitute a larger and larger fraction of the population globally.”
 

Still early days

Commenting on the findings, Heather Snyder, PhD, vice president of medical and scientific relations at the Alzheimer’s Association, noted that the investigators used an “interesting” diagnostic process.

“It was a unique approach to looking at and trying to understand what might be some of the biological underpinnings and using these tools and technologies to determine if they’re able to differentiate individuals with Alzheimer’s disease” from those without Alzheimer’s disease, said Dr. Snyder, who was not involved with the research.

“Ultimately, we want to know who is at greater risk, who may have some of the changing biology at the earliest time point so that we can intervene to stop the progression of the disease,” she said.

She pointed out that a number of types of biomarker tests are currently under investigation, many of which are measuring different outcomes. “And that’s what we want to see going forward. We want to have as many tools in our toolbox that allow us to accurately diagnose at that earliest time point,” Dr. Snyder said.

“At this point, [the current study] is still pretty early, so it needs to be replicated and then expanded to larger groups to really understand what they may be seeing,” she added.

Dr. Bahado-Singh, Dr. Imam, Dr. Graham, and Dr. Snyder have reported no relevant financial relationships.

A version of this article first appeared on Medscape.com.

A minimally invasive blood test along with artificial intelligence (AI) may flag early-stage Alzheimer’s disease, raising the prospect of early intervention when effective treatments become available.

In a study, investigators used six AI methodologies, including Deep Learning, to assess blood leukocyte epigenomic biomarkers. They found more than 150 genetic differences among study participants with Alzheimer’s disease in comparison with participants who did not have Alzheimer’s disease.

All of the AI platforms were effective in predicting Alzheimer’s disease. Deep Learning’s assessment of intragenic cytosine-phosphate-guanines (CpGs) had sensitivity and specificity rates of 97%.

“It’s almost as if the leukocytes have become a newspaper to tell us, ‘This is what is going on in the brain,’ “ lead author Ray Bahado-Singh, MD, chair of the department of obstetrics and gynecology, Oakland University, Auburn Hills, Mich., said in a news release.

The researchers noted that the findings, if replicated in future studies, may help in providing Alzheimer’s disease diagnoses “much earlier” in the disease process. “The holy grail is to identify patients in the preclinical stage so effective early interventions, including new medications, can be studied and ultimately used,” Dr. Bahado-Singh said.

“This certainly isn’t the final step in Alzheimer’s research, but I think this represents a significant change in direction,” he told attendees at a press briefing.

The findings were published online March 31 in PLOS ONE.
 

Silver tsunami

The investigators noted that Alzheimer’s disease is often diagnosed when the disease is in its later stages, after irreversible brain damage has occurred. “There is currently no cure for the disease, and the treatment is limited to drugs that attempt to treat symptoms and have little effect on the disease’s progression,” they noted.

Coinvestigator Khaled Imam, MD, director of geriatric medicine for Beaumont Health in Michigan, pointed out that although MRI and lumbar puncture can identify Alzheimer’s disease early on, the processes are expensive and/or invasive.

“Having biomarkers in the blood ... and being able to identify [Alzheimer’s disease] years before symptoms start, hopefully we’d be able to intervene early on in the process of the disease,” Dr. Imam said.

It is estimated that the number of Americans aged 85 and older will triple by 2050. This impending “silver tsunami,” which will come with a commensurate increase in Alzheimer’s disease cases, makes it even more important to be able to diagnose the disease early on, he noted.

The study included 24 individuals with late-onset Alzheimer’s disease (70.8% women; mean age, 83 years); 24 were deemed to be “cognitively healthy” (66.7% women; mean age, 80 years). About 500 ng of genomic DNA was extracted from whole-blood samples from each participant.

The researchers used the Infinium MethylationEPIC BeadChip array, and the samples were then examined for markers of methylation that would “indicate the disease process has started,” they noted.

In addition to Deep Learning, the five other AI platforms were the Support Vector Machine, Generalized Linear Model, Prediction Analysis for Microarrays, Random Forest, and Linear Discriminant Analysis.

These platforms were used to assess leukocyte genome changes. To predict Alzheimer’s disease, the researchers also used Ingenuity Pathway Analysis.
 

Significant “chemical changes”

Results showed that the Alzheimer’s disease group had 152 significantly differentially methylated CpGs in 171 genes in comparison with the non-Alzheimer’s disease group (false discovery rate P value < .05).

As a whole, using intragenic and intergenic/extragenic CpGs, the AI platforms were effective in predicting who had Alzheimer’s disease (area under the curve [AUC], ≥ 0.93). Using intragenic markers, the AUC for Deep Learning was 0.99.

“We looked at close to a million different sites, and we saw some chemical changes that we know are associated with alteration or change in gene function,” Dr. Bahado-Singh said.

Altered genes that were found in the Alzheimer’s disease group included CR1L, CTSV, S1PR1, and LTB4R – all of which “have been previously linked with Alzheimer’s disease and dementia,” the researchers noted. They also found the methylated genes CTSV and PRMT5, both of which have been previously associated with cardiovascular disease.

“A significant strength of our study is the novelty, i.e. the use of blood leukocytes to accurately detect Alzheimer’s disease and also for interrogating the pathogenesis of Alzheimer’s disease,” the investigators wrote.

Dr. Bahado-Singh said that the test let them identify changes in cells in the blood, “giving us a comprehensive account not only of the fact that the brain is being affected by Alzheimer’s disease but it’s telling us what kinds of processes are going on in the brain.

“Normally you don’t have access to the brain. This gives us a simple blood test to get an ongoing reading of the course of events in the brain – and potentially tell us very early on before the onset of symptoms,” he added.
 

Cautiously optimistic

During the question-and-answer session following his presentation at the briefing, Dr. Bahado-Singh reiterated that they are at a very early stage in the research and were not able to make clinical recommendations at this point. However, he added, “There was evidence that DNA methylation change could likely precede the onset of abnormalities in the cells that give rise to the disease.”

Coinvestigator Stewart Graham, PhD, director of Alzheimer’s research at Beaumont Health, added that although the initial study findings led to some excitement for the team, “we have to be very conservative with what we say.”

He noted that the findings need to be replicated in a more diverse population. Still, “we’re excited at the moment and looking forward to seeing what the future results hold,” Dr. Graham said.

Dr. Bahado-Singh said that if larger studies confirm the findings and the test is viable, it would make sense to use it as a screen for individuals older than 65. He noted that because of the aging of the population, “this subset of individuals will constitute a larger and larger fraction of the population globally.”
 

Still early days

Commenting on the findings, Heather Snyder, PhD, vice president of medical and scientific relations at the Alzheimer’s Association, noted that the investigators used an “interesting” diagnostic process.

“It was a unique approach to looking at and trying to understand what might be some of the biological underpinnings and using these tools and technologies to determine if they’re able to differentiate individuals with Alzheimer’s disease” from those without Alzheimer’s disease, said Dr. Snyder, who was not involved with the research.

“Ultimately, we want to know who is at greater risk, who may have some of the changing biology at the earliest time point so that we can intervene to stop the progression of the disease,” she said.

She pointed out that a number of types of biomarker tests are currently under investigation, many of which are measuring different outcomes. “And that’s what we want to see going forward. We want to have as many tools in our toolbox that allow us to accurately diagnose at that earliest time point,” Dr. Snyder said.

“At this point, [the current study] is still pretty early, so it needs to be replicated and then expanded to larger groups to really understand what they may be seeing,” she added.

Dr. Bahado-Singh, Dr. Imam, Dr. Graham, and Dr. Snyder have reported no relevant financial relationships.

A version of this article first appeared on Medscape.com.

Key clinical point: Frailty is positively associated with disease activity in rheumatoid arthritis (RA), and habitual fish intake may help prevent progression of frailty and RA.

Major finding: The presence of frailty was significantly associated with the disease activity score (Disease Activity Score 28-erythrocyte sedimentation rate; odds ratio [OR], 1.70; P less than .0001). Patients who consumed fish more than twice per week had a lower prevalence of frailty than those who consumed fish twice per week or lesser (OR, 0.35; P = .00060).

Study details: The data come from a cross-sectional study of 306 female outpatients with RA from the KURAMA cohort database.

Disclosures: KURAMA cohort study was supported by AMED and a grant from the Daiichi Sankyo Co. Ltd. M. Hashimoto, R Watanabe, K Nishitani, H Ito, K Ohmura, and S Matsuda reported to receive grants and/or speaker fees from various pharmaceutical companies including Bristol-Meyers, Mitsubishi Tanabe Pharma, Asahi-Kasei Pharma, Daiichi-Sankyo, etc. Some of the authors declared no conflicts of interest.

Source: Minamino H et al. Sci Rep. 2021 Mar 3. doi: 10.1038/s41598-021-84479-0.

Key clinical point: Frailty is positively associated with disease activity in rheumatoid arthritis (RA), and habitual fish intake may help prevent progression of frailty and RA.

Major finding: The presence of frailty was significantly associated with the disease activity score (Disease Activity Score 28-erythrocyte sedimentation rate; odds ratio [OR], 1.70; P less than .0001). Patients who consumed fish more than twice per week had a lower prevalence of frailty than those who consumed fish twice per week or lesser (OR, 0.35; P = .00060).

Study details: The data come from a cross-sectional study of 306 female outpatients with RA from the KURAMA cohort database.

Disclosures: KURAMA cohort study was supported by AMED and a grant from the Daiichi Sankyo Co. Ltd. M. Hashimoto, R Watanabe, K Nishitani, H Ito, K Ohmura, and S Matsuda reported to receive grants and/or speaker fees from various pharmaceutical companies including Bristol-Meyers, Mitsubishi Tanabe Pharma, Asahi-Kasei Pharma, Daiichi-Sankyo, etc. Some of the authors declared no conflicts of interest.

Source: Minamino H et al. Sci Rep. 2021 Mar 3. doi: 10.1038/s41598-021-84479-0.

Key clinical point: Frailty is positively associated with disease activity in rheumatoid arthritis (RA), and habitual fish intake may help prevent progression of frailty and RA.

Major finding: The presence of frailty was significantly associated with the disease activity score (Disease Activity Score 28-erythrocyte sedimentation rate; odds ratio [OR], 1.70; P less than .0001). Patients who consumed fish more than twice per week had a lower prevalence of frailty than those who consumed fish twice per week or lesser (OR, 0.35; P = .00060).

Study details: The data come from a cross-sectional study of 306 female outpatients with RA from the KURAMA cohort database.

Disclosures: KURAMA cohort study was supported by AMED and a grant from the Daiichi Sankyo Co. Ltd. M. Hashimoto, R Watanabe, K Nishitani, H Ito, K Ohmura, and S Matsuda reported to receive grants and/or speaker fees from various pharmaceutical companies including Bristol-Meyers, Mitsubishi Tanabe Pharma, Asahi-Kasei Pharma, Daiichi-Sankyo, etc. Some of the authors declared no conflicts of interest.

Source: Minamino H et al. Sci Rep. 2021 Mar 3. doi: 10.1038/s41598-021-84479-0.

Key clinical point: Rheumatoid arthritis (RA) is associated with poor long-term prognosis after myocardial infarction (MI).

Major finding: At 14-year follow-up after MI, the cumulative all-cause mortality risk was significantly higher among patients with vs. without RA (80.4% vs. 72.3%; hazard ratio [HR], 1.25; P less than .0001). Patients with RA had a higher risk for new MI (HR, 1.22; P = .0001) and revascularization (HR, 1.27; P = .002) after discharge from index MI.

Study details: This was a nationwide, multicenter, cohort register study of real-life MI patients with RA (n=1,614) retrospectively compared with propensity score-matched MI patients without RA (n=8,070).

Disclosures: This study was supported by grant funding from the Finnish Cultural Foundation, the Paulo Foundation, and the Finnish Governmental VTR-funding. A Palomäki, AM Kerola, M Malmberg, and V Kytö reported relevant relationships with various pharmaceutical companies and/or research organizations. The other author declared no conflicts of interest.

Source: Palomäki A et al. Rheumatology (Oxford). 2021 Mar 1. doi: 10.1093/rheumatology/keab204.

Key clinical point: Rheumatoid arthritis (RA) is associated with poor long-term prognosis after myocardial infarction (MI).

Major finding: At 14-year follow-up after MI, the cumulative all-cause mortality risk was significantly higher among patients with vs. without RA (80.4% vs. 72.3%; hazard ratio [HR], 1.25; P less than .0001). Patients with RA had a higher risk for new MI (HR, 1.22; P = .0001) and revascularization (HR, 1.27; P = .002) after discharge from index MI.

Study details: This was a nationwide, multicenter, cohort register study of real-life MI patients with RA (n=1,614) retrospectively compared with propensity score-matched MI patients without RA (n=8,070).

Disclosures: This study was supported by grant funding from the Finnish Cultural Foundation, the Paulo Foundation, and the Finnish Governmental VTR-funding. A Palomäki, AM Kerola, M Malmberg, and V Kytö reported relevant relationships with various pharmaceutical companies and/or research organizations. The other author declared no conflicts of interest.

Source: Palomäki A et al. Rheumatology (Oxford). 2021 Mar 1. doi: 10.1093/rheumatology/keab204.

Key clinical point: Rheumatoid arthritis (RA) is associated with poor long-term prognosis after myocardial infarction (MI).

Major finding: At 14-year follow-up after MI, the cumulative all-cause mortality risk was significantly higher among patients with vs. without RA (80.4% vs. 72.3%; hazard ratio [HR], 1.25; P less than .0001). Patients with RA had a higher risk for new MI (HR, 1.22; P = .0001) and revascularization (HR, 1.27; P = .002) after discharge from index MI.

Study details: This was a nationwide, multicenter, cohort register study of real-life MI patients with RA (n=1,614) retrospectively compared with propensity score-matched MI patients without RA (n=8,070).

Disclosures: This study was supported by grant funding from the Finnish Cultural Foundation, the Paulo Foundation, and the Finnish Governmental VTR-funding. A Palomäki, AM Kerola, M Malmberg, and V Kytö reported relevant relationships with various pharmaceutical companies and/or research organizations. The other author declared no conflicts of interest.

Source: Palomäki A et al. Rheumatology (Oxford). 2021 Mar 1. doi: 10.1093/rheumatology/keab204.

Key clinical point: Multi-Biomarker Disease Activity (MBDA) should not be preferred to assess clinically meaningful improvements in disease activity after repository corticotropin injection (RCI) therapy in patients with active rheumatoid arthritis (RA).

Major finding: RCI-mediated improvements in Disease Activity Score 28-erythrocyte sedimentation rate and Clinical Disease Activity Index scores suggested clinically meaningful improvement with more than 84% of patients meeting the minimal clinically important difference/minimally important difference criteria, which ranged from 26.3% to 34.7% for MBDA.

Study details: The data come from a multicenter, randomized, placebo-controlled study of 259 patients with active RA despite treatment with stable glucocorticoid dose and 1 or 2 disease-modifying anti-rheumatic drugs. Patients achieving low disease activity during open-label period were randomly assigned to either 80 U of RCI (n=77) or placebo (n=76) during the 12-week double-blind period.

Disclosures: This study was funded by Mallinckrodt Pharmaceuticals. R Fleischmann, DE Furst, and OG Segurado reported receiving clinical trial grants and consulting fees from various pharmaceutical companies including Mallinckrodt Pharmaceuticals. J Liu and J Zhu declared being employees of Mallinckrodt Pharmaceuticals.

Source: Fleischmann R et al. Arthritis Care Res (Hoboken). 2021 Feb 28. doi: 10.1002/acr.24583.

Key clinical point: Multi-Biomarker Disease Activity (MBDA) should not be preferred to assess clinically meaningful improvements in disease activity after repository corticotropin injection (RCI) therapy in patients with active rheumatoid arthritis (RA).

Major finding: RCI-mediated improvements in Disease Activity Score 28-erythrocyte sedimentation rate and Clinical Disease Activity Index scores suggested clinically meaningful improvement with more than 84% of patients meeting the minimal clinically important difference/minimally important difference criteria, which ranged from 26.3% to 34.7% for MBDA.

Study details: The data come from a multicenter, randomized, placebo-controlled study of 259 patients with active RA despite treatment with stable glucocorticoid dose and 1 or 2 disease-modifying anti-rheumatic drugs. Patients achieving low disease activity during open-label period were randomly assigned to either 80 U of RCI (n=77) or placebo (n=76) during the 12-week double-blind period.

Disclosures: This study was funded by Mallinckrodt Pharmaceuticals. R Fleischmann, DE Furst, and OG Segurado reported receiving clinical trial grants and consulting fees from various pharmaceutical companies including Mallinckrodt Pharmaceuticals. J Liu and J Zhu declared being employees of Mallinckrodt Pharmaceuticals.

Source: Fleischmann R et al. Arthritis Care Res (Hoboken). 2021 Feb 28. doi: 10.1002/acr.24583.

Key clinical point: Multi-Biomarker Disease Activity (MBDA) should not be preferred to assess clinically meaningful improvements in disease activity after repository corticotropin injection (RCI) therapy in patients with active rheumatoid arthritis (RA).

Major finding: RCI-mediated improvements in Disease Activity Score 28-erythrocyte sedimentation rate and Clinical Disease Activity Index scores suggested clinically meaningful improvement with more than 84% of patients meeting the minimal clinically important difference/minimally important difference criteria, which ranged from 26.3% to 34.7% for MBDA.

Study details: The data come from a multicenter, randomized, placebo-controlled study of 259 patients with active RA despite treatment with stable glucocorticoid dose and 1 or 2 disease-modifying anti-rheumatic drugs. Patients achieving low disease activity during open-label period were randomly assigned to either 80 U of RCI (n=77) or placebo (n=76) during the 12-week double-blind period.

Disclosures: This study was funded by Mallinckrodt Pharmaceuticals. R Fleischmann, DE Furst, and OG Segurado reported receiving clinical trial grants and consulting fees from various pharmaceutical companies including Mallinckrodt Pharmaceuticals. J Liu and J Zhu declared being employees of Mallinckrodt Pharmaceuticals.

Source: Fleischmann R et al. Arthritis Care Res (Hoboken). 2021 Feb 28. doi: 10.1002/acr.24583.

Key clinical point: Median durability of tocilizumab (TCZ) response was more than 3 years when measured as maintenance of minimum clinically important difference (MCID) in Clinical Disease Activity Index (CDAI) score in patients with RA initiating TCZ.

Major finding: Overall, durability of response among patients who initiated TCZ and achieved MCID in CDAI remained more than 50% after 3 years of follow-up. The proportion of patients maintaining MCID durability at 1, 2, and 3 years was 64.4% (95% CI, 59.2%-69.6%), 56.0% (95% CI, 50.0%-62.0%), and 51.8% (95% CI, 44.7%-58.9%), respectively.

Study details: The findings are from an observational study of 1,789 patients with RA who initiated TCZ and were enrolled in the US-based Corrona RA Registry.

Disclosures: This study was sponsored by Corrona LLC, and the analysis was funded by Genentech, Inc. DA Pappas, T Blachley, and K Emeanuru declared being employees and/or shareholders of Corrona, LLC. JH Best, WG Reiss, and S Zlotnick declared being current/former employees and/or shareholders of Genentech, Inc.

Source: Pappas DA et al. Rheumatol Ther. 2021 Feb 25. doi: 10.1007/s40744-021-00285-0.

Key clinical point: Median durability of tocilizumab (TCZ) response was more than 3 years when measured as maintenance of minimum clinically important difference (MCID) in Clinical Disease Activity Index (CDAI) score in patients with RA initiating TCZ.

Major finding: Overall, durability of response among patients who initiated TCZ and achieved MCID in CDAI remained more than 50% after 3 years of follow-up. The proportion of patients maintaining MCID durability at 1, 2, and 3 years was 64.4% (95% CI, 59.2%-69.6%), 56.0% (95% CI, 50.0%-62.0%), and 51.8% (95% CI, 44.7%-58.9%), respectively.

Study details: The findings are from an observational study of 1,789 patients with RA who initiated TCZ and were enrolled in the US-based Corrona RA Registry.

Disclosures: This study was sponsored by Corrona LLC, and the analysis was funded by Genentech, Inc. DA Pappas, T Blachley, and K Emeanuru declared being employees and/or shareholders of Corrona, LLC. JH Best, WG Reiss, and S Zlotnick declared being current/former employees and/or shareholders of Genentech, Inc.

Source: Pappas DA et al. Rheumatol Ther. 2021 Feb 25. doi: 10.1007/s40744-021-00285-0.

Key clinical point: Median durability of tocilizumab (TCZ) response was more than 3 years when measured as maintenance of minimum clinically important difference (MCID) in Clinical Disease Activity Index (CDAI) score in patients with RA initiating TCZ.

Major finding: Overall, durability of response among patients who initiated TCZ and achieved MCID in CDAI remained more than 50% after 3 years of follow-up. The proportion of patients maintaining MCID durability at 1, 2, and 3 years was 64.4% (95% CI, 59.2%-69.6%), 56.0% (95% CI, 50.0%-62.0%), and 51.8% (95% CI, 44.7%-58.9%), respectively.

Study details: The findings are from an observational study of 1,789 patients with RA who initiated TCZ and were enrolled in the US-based Corrona RA Registry.

Disclosures: This study was sponsored by Corrona LLC, and the analysis was funded by Genentech, Inc. DA Pappas, T Blachley, and K Emeanuru declared being employees and/or shareholders of Corrona, LLC. JH Best, WG Reiss, and S Zlotnick declared being current/former employees and/or shareholders of Genentech, Inc.

Source: Pappas DA et al. Rheumatol Ther. 2021 Feb 25. doi: 10.1007/s40744-021-00285-0.

Key clinical point: The addition of iguratimod (IGU) can effectively reduce methotrexate (MTX) dose required by rheumatoid arthritis (RA) patients with long-term clinical remission.

Major finding: MTX dose could be reduced from 8.6±2.4 mg/week to 4.7±2.2 mg/week at 36 weeks. Despite MTX dose reduction, disease activity score 28-erythrocyte sedimentation rate was maintained at 1.48 at baseline and 1.69 at 36 weeks (P = .911). Other than drug discontinuation by 2 patients in the IGU addition group, no other adverse events were observed.

Study details: Findings are from a prospective analysis of 47 patients with RA who had sustained clinical remission with MTX for more than 24 weeks. Patients either continued constant MTX dose (n=25) or were treated with additional IGU and tapered MTX dose (n=22).

Disclosures: No source of funding was declared. The authors declared no conflicts of interest.

Source: Yoshikawa A et al. Mod Rheumatol. 2021 Mar 16. doi: 10.1080/14397595.2021.1892945.

Key clinical point: The addition of iguratimod (IGU) can effectively reduce methotrexate (MTX) dose required by rheumatoid arthritis (RA) patients with long-term clinical remission.

Major finding: MTX dose could be reduced from 8.6±2.4 mg/week to 4.7±2.2 mg/week at 36 weeks. Despite MTX dose reduction, disease activity score 28-erythrocyte sedimentation rate was maintained at 1.48 at baseline and 1.69 at 36 weeks (P = .911). Other than drug discontinuation by 2 patients in the IGU addition group, no other adverse events were observed.

Study details: Findings are from a prospective analysis of 47 patients with RA who had sustained clinical remission with MTX for more than 24 weeks. Patients either continued constant MTX dose (n=25) or were treated with additional IGU and tapered MTX dose (n=22).

Disclosures: No source of funding was declared. The authors declared no conflicts of interest.

Source: Yoshikawa A et al. Mod Rheumatol. 2021 Mar 16. doi: 10.1080/14397595.2021.1892945.

Key clinical point: The addition of iguratimod (IGU) can effectively reduce methotrexate (MTX) dose required by rheumatoid arthritis (RA) patients with long-term clinical remission.

Major finding: MTX dose could be reduced from 8.6±2.4 mg/week to 4.7±2.2 mg/week at 36 weeks. Despite MTX dose reduction, disease activity score 28-erythrocyte sedimentation rate was maintained at 1.48 at baseline and 1.69 at 36 weeks (P = .911). Other than drug discontinuation by 2 patients in the IGU addition group, no other adverse events were observed.

Study details: Findings are from a prospective analysis of 47 patients with RA who had sustained clinical remission with MTX for more than 24 weeks. Patients either continued constant MTX dose (n=25) or were treated with additional IGU and tapered MTX dose (n=22).

Disclosures: No source of funding was declared. The authors declared no conflicts of interest.

Source: Yoshikawa A et al. Mod Rheumatol. 2021 Mar 16. doi: 10.1080/14397595.2021.1892945.