Upadacitinib as monotherapy in patients with active rheumatoid arthritis and inadequate response to methotrexate

Upadacitinib as monotherapy in patients with active rheumatoid arthritis and inadequate response to methotrexate

Methotrexate is regarded as being the first-line treatment in the management of rheumatoid arthritis. However, one-half to two-thirds of patients do not achieve satisfactory disease control.

Upadacitinib, which is an oral Janus Kinase selective inhibitor, has been shown to be helpful in combination with methotrexate for patients who do not respond adequately to methotrexate. In this study its potential value is assessed when it is used in such patients as the sole agent.

It was found that monotherapy showed statistically significant improvements compared with the use of upadacitinib and methotrexate in patients who had shown an inadequate response to methotrexate.

Lancet 2019; 393:2303–11

Effect of systolic and diastolic blood pressure on cardiovascular outcomes

The relationship between outpatient systolic and diastolic blood pressure and cardiovascular outcomes remains unclear and has been complicated by recently revised guidelines with two different thresholds (>140/90mmHg and >130/80mmHg) for treating hypertension.

In this study the researchers use data from 1.3 million adults to determine the effect of the burden of systolic and diastolic hypertension on a composite outcome of myocardial infarction, ischaemic stroke or haemorrhagic stroke over a period of eight years.

The researchers report that although systolic BP elevation had a greater effect on outcomes, both systolic and diastolic hypertension independently influenced the risk of adverse cardiovascular events regardless of the definition of hypertension (>140/90 or >130/80).

NEJM 2019; 381:243–51

Stress-related disorders and risk of cardiovascular disease

This population-based, sibling-controlled cohort study was carried out in Sweden. The stress-related disorders included were post-traumatic stress disorders, acute stress reactions, adjustment disorders and other stress reactions.

The incidence of serious cardiovascular disease in over 100,000 patients with stress-related disorders was compared with the incidence in over 10,000 unaffected full siblings of these patients. A comparison was also made with over 1,000,000 matched unexposed people from the Swedish general population. During a 27-year follow-up the incidence of any cardiovascular disease in the three cohorts was 10.5, 8.4 and 6.9 per 1,000 patient years respectively.

It was concluded that stress-related disorders are robustly associated with the subsequent incidence of serious cardiovascular disease.

BMJ 2019; 365:l1255

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