Weisman, Michael

Abstract Background. Pain drives disability and medication use in autoimmune rheumatic diseases (ARDs), even when inflammation is controlled. The extent of pain-related polypharmacy across ARDs and chronic overlapping pain conditions (COPCs) remains poorly characterized. We aimed to quantify first-year pain medication burden following ARD diagnosis and examine variations by disease, COPC status, and time. Methods. Using the Merative MarketScan Commercial Claims database, we identified adults newly diagnosed with rheumatoid arthritis, systemic lupus erythematosus, ankylosing spondylitis, psoriatic arthritis, Sjögren’s disease, or systemic sclerosis (2008–2021). We analyzed pain-related medications across ten pharmacologic categories during the first year post-diagnosis. Polypharmacy measures included distinct medication counts, medication categories, ≥ 5 and ≥ 10 medication thresholds, and the Medication Quantification Scale. Findings. Among 149,742 adults with newly diagnosed ARDs, 57.6% had at least one COPC. During the first year after diagnosis, patients filled a mean of 9.0 distinct pain medications and 47.9% met criteria for ≥ 5 medications; 30.5% met criteria for ≥ 10 medications. Ankylosing spondylitis demonstrated the highest medication burden (mean 11.6 medications; 57.5% with ≥ 5 medications; 37.9% with ≥ 10 medications). Patients with fibromyalgia had consistently higher medication burden across ARDs and were the only COPC group in whom prescribing increased after 2015. Overall medication burden rose from 2008 to 2014–2015 and declined thereafter; however, absolute levels remained high. Interpretation. Pain-related polypharmacy is common early after ARD diagnosis and varies substantially by disease and pain phenotype. Despite modest declines after 2015, medication burden remains high, underscoring the need for phenotype-informed, nonpharmacologic, and deprescribing strategies in rheumatology. Funding. NIAMS (K01AR079039).

ObjectiveTo compare the efficacy of abatacept to that of placebo for the treatment of giant cell arteritis (GCA).MethodsIn this multicenter trial, patients with newly diagnosed or relapsing GCA were treated with abatacept 10 mg/kg intravenously on days 1, 15, and 29 and week 8, together with prednisone administered daily. At week 12, patients in remission underwent a double‐blinded randomization to continue to receive abatacept monthly or switch to placebo. Patients in both study arms received a standardized prednisone taper, with discontinuation of prednisone at week 28. All patients remained on their randomized assignment until meeting criteria for early termination or until 12 months after enrollment of the last patient. The primary end point was duration of remission (relapse‐free survival rate).ResultsForty‐nine eligible patients with GCA were enrolled and treated with prednisone and abatacept; of these, 41 reached the week 12 randomization and underwent a blinded randomization to receive abatacept or placebo. Prednisone was tapered using a standardized schedule, reaching a daily dosage of 20 mg at week 12 with discontinuation in all patients at week 28. The relapse‐free survival rate at 12 months was 48% for those receiving abatacept and 31% for those receiving placebo (P = 0.049). A longer median duration of remission was seen in those receiving abatacept compared to those receiving placebo (median duration 9.9 months versus 3.9 months; P = 0.023). There was no difference in the frequency or severity of adverse events, including infection, between the treatment arms.ConclusionIn patients with GCA, the addition of abatacept to a treatment regimen with prednisone reduced the risk of relapse and was not associated with a higher rate of toxicity compared to prednisone alone.

Objective To compare the efficacy of abatacept to that of placebo for the treatment of Takayasu arteritis (TAK). Methods In this multicenter trial, patients with newly diagnosed or relapsing TAK were treated with abatacept 10 mg/kg intravenously on days 1, 15, and 29 and week 8, together with prednisone administered daily. At week 12, patients in remission underwent a double‐blinded randomization to continue to receive abatacept monthly or switch to placebo. Patients in both study arms received a standardized prednisone taper, reaching a dosage of 20 mg daily at week 12, with discontinuation of prednisone at week 28. All patients remained on their randomized assignment until meeting criteria for early termination or until 12 months after enrollment of the last patient. The primary end point was duration of remission (relapse‐free survival). Results Thirty‐four eligible patients with TAK were enrolled and treated with prednisone and abatacept; of these, 26 reached the week 12 randomization and underwent a blinded randomization to receive either abatacept or placebo. The relapse‐free survival rate at 12 months was 22% for those receiving abatacept and 40% for those receiving placebo ( P = 0.853). Treatment with abatacept in patients with TAK enrolled in this study was not associated with a longer median duration of remission (median duration 5.5 months for abatacept versus 5.7 months for placebo). There was no difference in the frequency or severity of adverse events, including infection, between the treatment arms. Conclusion In patients with TAK, the addition of abatacept to a treatment regimen with prednisone did not reduce the risk of relapse.