Rheumatology

Updated SLR sharpens evidence base for 2025 EULAR RA recommendations

This systematic review included 72 RCTs of csDMARDs, bDMARDs, tsDMARDs, glucocorticoids, biosimilars, and antifibrotics in RA. Phase 3–4 trials evaluated established csDMARDs, newer biologics, JAK inhibitors, and strategic comparisons with conventional therapy. Strategic studies examined b/tsDMARD-based versus conventional strategies, synovial biopsy-guided treatment, drug monitoring, and DMARD tapering. Additional RCTs addressed RA-ILD antifibrotics and DMARDs or glucocorticoids for RA prevention in at-risk populations. These data underpin refinement of the 2025 EULAR RA treatment algorithm despite few phase 3 trials of novel agents. 1

Dose-dependent benefit of low-dose IL-2 in active SLE

In this phase IIb trial, 152 patients with active SLE received subcutaneous low-dose IL-2 (three doses) or placebo for 24 weeks. At week 12, SRI-4 responses were higher with all IL-2 doses than placebo, especially 0.5 and 1.0 million IU. Benefits persisted to week 24, with dose-dependent increases in LLDAS and improvements in PGA, anti-dsDNA, and prednisone at 1.0 million IU. Infection rates were lower with IL-2 than placebo, while IL-2 expanded regulatory T cells and altered Treg/effector T-cell ratios. 2

Anti-FcRn therapy efgartigimod shows proof-of-concept in Sjögren’s

In this phase 2 trial, 34 adults with Sjögren’s disease were randomised 2:1 to efgartigimod IV 10 mg/kg weekly or placebo for 24 weeks. More efgartigimod-treated patients met CRESS response on at least three of five domains at week 24 versus placebo (45.5% vs 11.1%). Efgartigimod also increased the proportion achieving cSTAR score ≥5 and scored higher on four of five CRESS items. Adverse events were more frequent with efgartigimod but all were grade 1–2, supporting acceptable tolerability. Despite small numbers and no formal hypothesis testing, these results support phase 3 evaluation of FcRn blockade in Sjögren’s. 3