Friday, 17 Nov 2017

You are here

ACR 2017 - Day 1 Highlights

Curtis and colleagues presented a plenary session that analyzed the duration of drug holidays and the risk of subsequent fractures (FX) in women starting bisphosphonates (BP). They looked at 156,236 women taking BP for 3 years (median 2.1 yrs.) and then discontinuing BP.  20% stopped BP for > 6 mos. and 12.7% restarted BP and 11% died. For those off BP for >2 yrs. there was a 40% increased risk of Hip Fx. Those stopping Alendronate for > 2 years there was a 20% increase in hip Fx.  Major osteoporotic Fx were increased 10% only after 2+ year drug holiday. For women with a history of prior Fx, a drug holiday was associated with doubling of the Fx risk (200%).

Abstract 141 - Kersley-Fleet and coworkers with the British Society of Rheumatology Biologics Registry (BSRBR) examined their large cohort of biologic treated rheumatoid arthritis (RA) patients (N=13502) to examine the frequency, characteristics and predictive value of those with “refractory” RA. Such patients were defined as those who required biologic switching to a 3rd biologic class. They identified refractory RA in 6.4% of all BSRBR patients. These patients were likely to leave their first biologic class (TNF inhibitors) for insufficient response and 83% used rituximab as their 2nd biologic class. For a qualifying 3rd “MOA” change 59% were put on tocilizumab and 23% changed to abatacept. Predictors of “refractory” status included being female, age <50yrs., higher joint counts, ESR, and patient global assessment. In addition >3 comorbidities, current smoker and obesity contributed to a refractory status. Overall, refractory disease included those with more active RA parameters but was worsened by comorbidity, smoking and obesity – cofactors previously known to worsen RA and possibly contributes to RA risk.

Park and colleagues from Korea had a novel prospective study that looked at optimization of influenza vaccine results in RA patients. Multiple studies have previously and consistently shown that MTX blunts vaccine responses. Based on pilot studies, RA patients on MTX either continued or held MTX for 2 weeks upon receiving seasonal influenza vaccinations. The dose of MTX was ~13 mg per week. They showed that holding MTX for 2 weeks did not lead to RA worsening, but did significantly augment vaccine effects, 4 fold elevation of viral titers and seroconversion. Such findings suggest this practice would be advantageous to those who will receive the influenza vaccine. 

 

Disclosures: 
The author has no conflicts of interest to disclose related to this subject

Rheumatologists' Comments

Does biologic drugs like MTX blunt influenza vaccine response and then what should we do? Could we stop biologic drugs prior to vaccination and what time ?

More Like This

The Greatest Rheumatologist - Part I

Who is the greatest rheumatologist? What makes for a great rheum? Is it clinical acumen, scientific achievement, educational prowess or years of unrivaled service or mentoring? Rheumatologists are quite opinionated on this subject and very nostalgic about their mentors and leaders. When I’ve posed this question in small groups, it’s plain to see how moved they become when discussing mentors or peers who influenced them. Thus, I posed this question to many of our leaders and mentors: who do you think of as the greatest rheumatologist?

Top 16 Drugs in Rheumatology 2016

Using data compiled from annual reports, SEC filings, press releases, company websites, recently released sales figures show that in 2016, 11 of the top 16 rheumatology drugs demonstrated blockbuster sales (>$1 billion per annum).  Highlights from this report include:

Rheumatologists are Slow to Change DMARDs

The paradigm of rheumatoid arthritis (RA) therapy mandates early diagnosis and aggressive treatment.  Yet a recent cohort study has shown that RA patients with moderate to high disease activity (MHDAS) were met with infrequent DMARD adjustments; with median time to DMARD adjustment being 5 months and median time to low disease activity (LDAS) was roughly 10 months. 

Novel Gel Drug Delivery Developed for Rheumatoid Arthritis

Scientists at the Institute for Basic Science have invented a hydrogel capable of delivering drug at sites of inflammation in disorders such as rheumatoid arthritis. Published in Advanced Materials, this jelly-like material could be used to absorb extra fluids in swelling joints and release drugs wherever nitric oxide is produced in abundance.

2016 EULAR Guidelines on RA Management

The management of rheumatoid arthritis (RA) has evolved significantly with time.  Nevertheless, there are still some uncertainties - such as when, what and which biologic or novel therapy should be used.