Efficacy and safety of tildrakizumab in patients with active psoriatic arthritis: results of a randomised, double-blind, placebo-controlled, multiple-dose, 52-week phase IIb study.

Objectives: To evaluate efficacy and safety of the anti-interleukin-23p19 monoclonal antibody tildrakizumab in patients with psoriatic arthritis (PsA).

Methods: In this randomised, double-blind, placebo-controlled, phase IIb study, patients with active PsA were randomised 1:1:1:1:1 to tildrakizumab 200 mg every 4 weeks (Q4W); tildrakizumab 200, 100 or 20 mg Q12W; or placebo Q4W. Patients receiving tildrakizumab 20 mg or placebo switched to tildrakizumab 200 mg Q12W at W24; treatment continued to W52.

Long-term management of gout: nonpharmacologic and pharmacologic therapies.

Gout is a common disorder with clinical signs and symptoms resulting from inflammatory responses to monosodium urate crystals deposited in tissues from extracellular fluids saturated for urate. Long-term management of gout focuses on nonpharmacologic and pharmacologic means to achieve and maintain serum urate levels in a subsaturating range. Despite a firm understanding of gout pathophysiology, means to achieve certain diagnosis, and a variety of effective therapies, treatment outcomes remain suboptimal.

Cardiovascular safety of febuxostat and allopurinol in patients with gout and cardiovascular comorbidities.

Comprehensive safety evaluation of new drugs for noncardiac indications is needed in the area of cardiovascular (CV) outcomes, particularly in populations with high CV risk such as gout. Febuxostat is a potent nonpurine selective inhibitor of xanthine oxidase approved for the treatment of gout. Long-term CV safety of febuxostat is being established in a randomized, allopurinol-controlled clinical study in patients with gout who have increased CV risk using an analytical approach that provides 90% power to meet a noninferiority margin of 1.

Women with gout: efficacy and safety of urate-lowering with febuxostat and allopurinol.

Objective: To compare the characteristics of female versus male gout patients and assess urate-lowering efficacy and safety of febuxostat or allopurinol treatment in women with gout.

Methods: This was a retrospective analysis of 4,101 hyperuricemic (serum urate [sUA] level ≥8.0 mg/dl) gout subjects enrolled in 3 phase III comparative trials and randomized to receive placebo, febuxostat (40 mg, 80 mg, 120 mg, or 240 mg daily), or allopurinol (100 mg, 200 mg, or 300 mg daily, based on renal function).

Safety and efficacy of febuxostat treatment in subjects with gout and severe allopurinol adverse reactions.

Objective: Allopurinol, a purine base analog inhibitor of xanthine oxidase (XO) activity, remains the standard for pharmacologic urate-lowering management of gout. Allopurinol is efficacious and safe in most patients, but intolerance is estimated to occur in up to 10% of treated patients. Severe or life-threatening allopurinol adverse reactions (AE) occur much less frequently, and include severe cutaneous allopurinol reactions, vasculitis, and/or a multisystem allopurinol hypersensitivity syndrome.

Update on emerging urate-lowering therapies.

Purpose Of Review: To discuss currently available urate-lowering therapeutic options for gout in the United States and newer therapeutic initiatives in development.

Recent Findings: Currently available urate-lowering drugs include allopurinol and probenecid. These drugs are effective but are often underdosed or underutilized, and caution must be taken in patients with multiple comorbidities.

Acute myocardial infarction after treatment of thrombocytopenia in a young woman with systemic lupus erythematosus.

We describe a case of an acute myocardial infarction (MI) coincident with correction of severe thrombocytopenia in a 23-year old African American woman with systemic lupus erythematosus (SLE) in the absence of coronary artery disease on angiography. Despite a history of anticardiolipin and beta(2)-glycoprotein I antibodies, she had no prior thromboembolic events. The occurrence of an acute MI after rapid normalization in the platelet count suggests the need for close monitoring of possible cardiovascular events during and after treatment of severe thrombocytopenia in the presence of antiphospholipid antibodies.

Correlates of formal work disability in an urban university systemic lupus erythematosus practice.

Objective: Work disability in systemic lupus erythematosus (SLE) has been sparsely studied. We sought to determine the demographic, disease-specific, and psychological features associated with work disability in patients with SLE at our medical center.

Methods: Ambulatory patients with SLE were enrolled in a cross-sectional study.

We can make gout management more successful now.

Purpose Of Review: The purpose of this editorial review is to identify and comment on factors contributing to the current less-than-optimal state of gout management and to emphasize immediate opportunities to improve management practices affecting many patients with gout.

Recent Findings: Numerous publications document deficits in the current management and clinical outcomes of gout despite detailed understanding of the pathogenesis and pathophysiology of the disorder, the ability to establish the diagnosis with certainty, and the likely effectiveness, for most patients, of available lifestyle and pharmacological interventions. Among impediments to successful gout management are diagnostic inaccuracy; a paucity of validated management recommendations to guide care providers; incomplete patient education about gout and the aims and modalities of management; suboptimal patient adherence, even to demonstrably effective therapeutic recommendations; comorbidities and drug interferences that complicate treatment of gout; patient groups at special risk for progression to chronic tophaceous gout; and limited urate-lowering alternatives.

Whole blood viscosity and arterial thrombotic events in patients with systemic lupus erythematosus.

Objective: To determine if whole blood viscosity (WBV), a rheologic variable contributing to risk of myocardial infarction and stroke in the general population, is elevated in patients with systemic lupus erythematosus (SLE), particularly SLE patients with a history of thrombotic or atherothrombotic events. Because the high rates of arterial and venous thrombosis in lupus cannot be explained by traditional risk factors, elevated WBV may be an easily measurable nontraditional risk factor to identify SLE patients at high risk for thrombotic events.

Methods: Sixty SLE patients (30 with a history of a thrombotic event) and 20 matched controls were recruited into the study.