Monday, 20 May 2019

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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. 


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 ?

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