Faculty Bibliography

OBJECTIVES/OBJECTIVE:To determine the efficacy, safety, and tolerability of intraarticular (IA) lorecivivint (LOR) in the treatment of knee osteoarthritis (OA). METHODS:Patients with American College of Rheumatology criteria-defined knee OA, Kellgren-Lawrence (KL) grades 2-3, and medial Joint Space Width (JSW) by radiograph between 1.5 and 4 mm in the target knee were enrolled in this phase 3, 56-week, multicentre, double-blind, placebo-controlled study. Patients were randomised (1:1) to receive a single IA injection of 0.07 mg LOR or vehicle placebo (PBO) on Day 1. The primary endpoint was the change from baseline in pain Numeric Rating Scale (NRS) at Week 12. Additional outcomes included the change from baseline in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Function, WOMAC Pain, Patient Global Assessment, medial JSW, and safety. RESULTS:513 patients were randomised. Baseline mean medial JSW was 2.61 (±0.7) mm. The mean change from baseline in weekly average of daily Pain NRS at Week 12 was LOR -2.24 (± 0.13) compared with PBO -2.49 (± 0.13); p=0.185, 95% confidence interval (CI) (-0.12, 0.62). No discernable treatment effects of LOR compared with PBO were revealed by the analysis of other endpoints. Neither treatment group showed meaningful medial JSW loss over 52 weeks. Incidences, severity, and relationship to study treatment of AEs were similar between LOR and PBO treatment groups. CONCLUSIOINS/UNASSIGNED:In this study, LOR was well tolerated although it did not meet the primary endpoint of change from baseline in target knee Pain NRS at Week 12.

OBJECTIVES/OBJECTIVE:To assess the efficacy and safety of an intra-articular (IA) CLK/DYRK inhibitor, lorecivivint (LOR), for the treatment of moderate to severe symptomatic knee osteoarthritis (OA). METHODS:This was a Phase 3, 28-week, multicentre, double-blind, placebo-controlled study evaluating the efficacy and safety of a single IA injection of LOR. Patients with ACR-defined knee OA, Kellgren-Lawrence (KL) grades 2-3, and pain Numeric Rating Scale (NRS) ≥4 and ≤8 in the target knee were randomised (1:1) to receive LOR 0.07 mg or vehicle placebo (PBO) on Day 1. The primary endpoint was the change from baseline in Pain NRS at Week 12 between LOR and PBO. Additional outcomes included the change from baseline in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Function, WOMAC Pain, Patient Global Assessment and safety. RESULTS:498 patients were randomised, and 51.9% had KL Grade 3 severity. In the full analysis set (FAS), LOR failed to meet the primary endpoint when compared to PBO. No significant treatment differences were noted in other efficacy endpoints. A post-hoc analysis demonstrated a positive treatment effect of LOR relative to PBO in the KL Grade 2 subgroup; the difference in weekly Pain NRS between LOR and PBO groups showed nominal statistical significance at Week 4 (p<0.05). Incidences, seriousness, and severity of adverse events were similar across the treatment groups. CONCLUSIONS:LOR was well tolerated despite not meeting the primary endpoint. Efficacy signals were identified in patients with less severe structural knee OA disease, suggesting earlier intervention may be more effective.

PURPOSE OF REVIEW/OBJECTIVE:This review will attempt to summarize the most potentially impactful new data on the way ANCA-associated vasculitis (AAV) is diagnosed, treated, and monitored. RECENT FINDINGS/RESULTS:The newly developed classification criteria for AAV have serious methodological issues that need to be addressed before they are widely adopted. The newly approved drugs and studies into both achieving remission and maintaining it have added to our overall knowledge of managing AAV and should hopefully contribute to improving outcomes in AAV. SUMMARY/CONCLUSIONS:The diagnosis, treatment and monitoring of AAV have seen major improvements in the last two years. The remaining issues outlined in this review still need to be addressed to best serve AAV patients.

INTRODUCTION/BACKGROUND:Knee osteoarthritis (OA) is a common painful disorder. Intra-articular (IA) corticosteroid injections are frequently prescribed to treat knee pain. Lorecivivint (LOR), a novel IA cdc2-Like Kinase (CLK)/Dual-Specificity Tyrosine Phosphorylation-Regulated Kinase (DYRK) inhibitor thought to modulate Wnt and inflammatory pathways, has appeared safe and demonstrated improved patient-reported outcomes compared with placebo. While LOR is proposed for stand-alone use, in clinical practice, providers might administer LOR in close time proximity to IA corticosteroid. This open-label, parallel-arm, healthy volunteer study assessed potential short-term safety, tolerability and pharmacokinetic (PK) interactions between IA LOR and triamcinolone acetonide (TCA) administered 7 days apart. METHODS:Healthy volunteers were randomized to Treatment Sequence 1 (IA 40 mg TCA followed by IA 0.07 mg LOR) or Treatment Sequence 2 (IA 0.07 mg LOR followed by IA 40 mg TCA). Treatment-emergent adverse events (TEAEs) were categorized by "epoch", with epoch 1 spanning from first until second injection, and epoch 2 spanning from second injection until end of study. Plasma PK was assessed pre injection and out to 22 days after to assess PK treatment interaction. RESULTS:A total of 18 TEAEs were reported by 11 (27.5%) of 40 enrolled participants, and there were no serious adverse events. Thirteen TEAEs were reported in Treatment Sequence 1 and five in Treatment Sequence 2, similarly distributed between epochs 1 and 2. In all participants and at all time points, plasma LOR concentrations were below the limit of quantification (0.100 ng/mL). Geometric mean concentrations and PK parameters for TCA were similar between treatment sequences. CONCLUSION/CONCLUSIONS:No safety signals were observed. There were no quantifiable plasma concentrations of LOR in either Treatment Sequence. The PK of TCA was unaffected by previous LOR injection. These results suggest that IA administration of LOR and TCA in close time proximity is unlikely to pose a safety concern. TRIAL REGISTRATION/BACKGROUND:ClinicalTrials.gov identifier, NCT04598542.

Behçet's syndrome is a systemic vasculitis affecting arteries and veins of all sizes as well as recurrent oral, genital, and intestinal ulcers, skin lesions, predominantly posterior uveitis, and parenchymal brain lesions. These can be present in various combinations and sequences over time and diagnosis is made by recognizing the manifestations, as there are no diagnostic biomarkers or genetic tests. Treatment modalities include immunomodulatory agents, immunosuppressives and biologics, tailored according to prognostic factors, disease activity, severity, and patients' preferences.

Disease assessment has been challenging in Behçet syndrome due to the heterogeneous disease course and multiorgan involvement with variable treatment response. There have been several recent improvements regarding outcome measures including development of a Core Set of Domains for Behçet syndrome and novel instruments for assessing specific organs and overall damage. This review focuses on the current state of outcome measures in Behçet syndrome, unmet needs, and a research agenda towards the development of standardized and validated outcome measure instruments.

Behcet syndrome is a systemic vasculitis which can involve many different organ systems. As such, treatment decisions need to be based on organ system involved. In addition, specific patient characteristics potentially predict milder or more severe course, and all these factors need to be taken into consideration when making treatment decisions. In this paper, we review the current approaches to treating Behcet syndrome patients.