VIDEO: New molecules, digital health applications and more drive excitement in RA research

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There is a lot of excitement in the field, particularly as we learn more about the biology of rheumatoid arthritis and of its comorbidities. And there are additional therapeutics that are being tested to be added to our current armamentarium against symptoms of rheumatoid arthritis. Speaking about the biology of rheumatoid arthritis, there has been really cool research that was published last year in Nature that combined data from single-cell RNA sequencing, surface protein data and histology of the synovial tissue that enabled researchers to build what they call the single-cell atlas of the rheumatoid arthritis synovial tissue. And basically, they were able to stratify the tissues into six groups that they referred to as cell-type abundance phenotype, which are characterized by selectively enriched cell states. And what they found is these phenotypes are very diverse. There are samples that have a lot of T cells and B cells, and then there are some samples that lack any lymphocytes. And what's interesting is that they also found that these phenotypes are related to treatment response, and this highlights the clinical utility of classifying rheumatoid arthritis based on synovial phenotypes. So that's, I think, a really, really cool finding.

The other interesting research that also was recently published involves the study into the biology of cardiovascular disease. We know that people with rheumatoid arthritis are prone to cardiovascular disease, but the exact mechanism for a cardiovascular disease in patients with rheumatoid arthritis is not really well understood. And there was this study that looked at a type of resolvin, resolvin T4, which was found to be used in levels in an experimental arthritis model. And what was even more interesting is that when the researchers, they are treating mice with resolvin T4, they found reduced blood inflammation by reprogramming the macrophages. So that gives us a glimpse of cardiovascular disease biology in patients with rheumatoid arthritis, and perhaps these findings can help with new treatments in the future.

I mentioned a little bit about additional molecules being tested for effectiveness in rheumatoid arthritis. One such new molecule is peresolimab (Eli Lilly), which is a humanized IgG1 monoclonal antibody that is designed to stimulate PD-1 inhibitory pathway. This PD-1 protein is a critical inhibitory receptor for lymphocyte activation, a sort of immune checkpoint that prevents continued activation of T cells. So stimulating this PD-1 pathway would be a new approach to treat rheumatoid arthritis symptoms. There was a phase 2A clinical trial that was positive for this molecule. So I'm sure that soon we're going to see data from a phase three study and hopefully will also be positive. And then we will have another type of approach to treat patients with rheumatoid arthritis.

Another new molecule that has been recently tested, it's called ocrelizumab (Ocrevus, Genentech). It's a anti IL-6 molecule. Inhibiting IL-6 is not new in rheumatoid arthritis certainly, but it's still interesting to hear that potentially new agents are developed against this IL-6 molecule. The ocrelizumab was tested in a phase three trial and the results were positive and recently published.

Digital health, I think it's a very exciting area in rheumatoid arthritis because it offers us the ability to interact with patients in different ways. You may have heard about the variety of digital applications that have been developed in hopes that they can be used by patients in between visits to report symptoms, and thus to provide more of a holistic picture, if you will, to the rheumatologist in between visits, because typically most of our interaction is just in person at the clinic visit with a patient with rheumatoid arthritis. And there was a recent study that looked at whether monitoring after or in between clinic visits is associated with any improvements in disease activity. And I was really excited to see that that was the case because many times applications are developed, but even with the best advice and stakeholder input, they are not associated with favorable results or they don't show a meaningful improvement in disease activity or other aspect of management of any chronic disease, including rheumatoid arthritis. So I'm sure there will be more to see about digital health applications in the future.