In a retrospective chart review of patients with rheumatoid arthritis (RA) and overweight or obesity, treatment with GLP-1 receptor agonists (semaglutide or tirzepatide) led to meaningful improvements in both RA disease activity and cardiovascular risk factors. Compared with controls who were prescribed but did not take a GLP-1RA, treated patients experienced significantly greater reductions in RA disease activity, joint pain, body weight, total cholesterol, and HbA1c over one year. Within the treatment group, additional benefits included lowered inflammatory markers (ESR and CRP), LDL cholesterol, and triglycerides. These encouraging findings suggest that GLP-1RAs may offer dual benefits for RA patients struggling with excess weight, potentially improving both rheumatic and cardiometabolic outcomes in clinical practice.

A large international observational study involving over 2,000 patients with systemic lupus erythematosus (SLE) suggests that monitoring hydroxychloroquine (HCQ) blood levels may be more effective than weight-based dosing alone for optimizing therapy. Researchers identified an upper therapeutic threshold of approximately 1,150 ng/mL, above which the risk of HCQ-related toxicity significantly increases while additional disease control benefits plateau. Patients with chronic kidney disease stage 3 or higher were more than twice as likely to reach these supratherapeutic levels. The proposed reference range of 750 to <1,150 ng/mL could help clinicians better balance efficacy and safety, particularly in patients with impaired renal function.

In a randomized, placebo-controlled trial, monthly subcutaneous ianalumab — a novel monoclonal antibody that both depletes B cells and blocks BAFF receptor signaling — demonstrated clinically meaningful efficacy in patients with active systemic lupus erythematosus (SLE) when added to standard therapy. At week 28, significantly more patients achieved the primary composite endpoint of SRI-4 response with successful corticosteroid tapering on ianalumab compared with placebo (44.1% vs 9.1%). Benefits were sustained through week 52 and replicated when placebo patients crossed over to open-label ianalumab, with consistent improvements across multiple disease activity measures, flare reduction, and steroid use. Ianalumab was generally well tolerated, with no increase in serious adverse events or infections, though mild injection-site reactions were more common. These early results support ianalumab as a promising new targeted therapy for SLE.

A recent review highlights the evolving treatment landscape for neuropsychiatric systemic lupus erythematosus (NPSLE), particularly diffuse central nervous system manifestations. Beyond traditional broad immunosuppression, three promising therapeutic approaches are emerging: targeted modulation of B-cell activity and autoantibodies (including CAR-T cell and BTK inhibitor therapies), reduction of systemic inflammation through JAK, TYK2, and anti-IFN agents, and direct neuroprotective strategies using ACE inhibitors and ARBs. These options, informed by murine models and advanced neuroimaging in patients, offer the potential for more precise and effective management of this challenging aspect of SLE. The authors emphasize the urgent need for dedicated clinical trials that specifically include NPSLE patients to validate these novel strategies in clinical practice.

In a multicentre randomised controlled trial conducted in the Netherlands, researchers compared an early intensive treat-to-target strategy using secukinumab plus methotrexate versus a conventional step-up treat-to-target approach with methotrexate in patients with newly diagnosed psoriatic arthritis (PsA) who were DMARD-naïve. At 6 months, the proportion of patients achieving an ACR50 response was numerically higher with early secukinumab (42%) than with standard care (35%), but the difference was not statistically significant. By 12 months, both strategies yielded similar clinical improvements, with approximately half of all patients reaching ACR50. Safety profiles were comparable between groups, with no new safety signals observed. These findings indicate that while early intensive IL-17A inhibition did not demonstrate clear superiority, both treat-to-target approaches effectively improved outcomes in early PsA, supporting the value of structured treatment escalation regardless of the initial regimen.