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ORAL Surveillance - Is Statin Use the Problem/Solution?
The findings from ORAL Surveillance Study have been a dominant conversation at recent ACR Convergence, with the seminal findings and subsequent analyses a target of debate. Subsequent post-hoc analyses, follow-up studies, and claims data analyses have been used to further interpret the data, though a clear answer on safety is not certain. A study presented on Sunday reported on a new post-hoc analysis that provides new insights.
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Biosimilar switching in practice
Hyrich: UK experience
Switching to biosimilar has no immediate benefit to patients but saves NHS money
Allows for gain share that can be re-invested in pt care
Transparency in switching in explaining to pts and offering resource
@RheumNow #ACR24
Eric Dein ericdeinmd ( View Tweet)
Hyrich:
ETN originator vs biosimilar initiation
- DAS28 - no signif change at B/L, 6mo, 12 mo.
Switch?
Matched pts in ETN switch v cont originator - good b/l control on Rx
-DAS28 maintained w switch
10% did go back to originator, felt less good tho similar DAS
#ACR24 @RheumNow https://t.co/RHRit5CtUu
Eric Dein ericdeinmd ( View Tweet)
A Bayesian Network Meta-analysis Phase II/III/IV, placebo-controlled, randomised clinical trials and long-term extension studies of JAKi and TNFi, in adults with RA, PsO, PsA, axial
spondyloarthritis axSpA and IBD showed the following:
- TNFi was associated with a significantly… https://t.co/FWHgemEAvG https://t.co/3D0nldwmwA
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
A Bayesian Network Meta-analysis Phase II/III/IV, placebo-controlled, randomised clinical trials and long-term extension studies of JAKi and TNFi, in adults with RA, PsO, PsA, axial
spondyloarthritis axSpA and IBD showed the following:
- TNFi was associated with a significantly… https://t.co/FWHgemEAvG https://t.co/3D0nldwmwA
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
If a mother has had TNFi during pregnancy, can a baby have a live oral rotavirus vaccine (usually at 2mo)?
This claims data suggests no increase in diarrhoea
Adds to similarly reassuring 🇨🇦prospective cohort data https://t.co/2Tz9zRhPjz
Vaccinate away!
#ACR24 ABST0806 @RheumNow https://t.co/66OIAR8W6l
David Liew drdavidliew ( View Tweet)
If a mother has had TNFi during pregnancy, can a baby have a live oral rotavirus vaccine (usually at 2mo)?
This claims data suggests no increase in diarrhoea
Adds to similarly reassuring 🇨🇦prospective cohort data https://t.co/2Tz9zRhPjz
Vaccinate away!
#ACR24 ABST0806 @RheumNow https://t.co/66OIAR8W6l
David Liew drdavidliew ( View Tweet)
Instead of just JAKi, why don't we look at all our RA meds and MACE risk
FAERS data & reporting odds ratios here: all the caveats of voluntary reporting, so don't put too much weight, but...
prednisone. Don't forget pred is really not great for MACE!
#ACR24 ABST1981 @RheumNow https://t.co/L9SlPZF2Jd
David Liew drdavidliew ( View Tweet)
Should you worry about giving TNFi to RA pts after a cancer diagnosis?
Medicare data with colorectal, lung, prostate Ca:
TNFi pts survival no worse (numerically better) than csDMARDs
Cancer pts deserve good RA treatment!
#ACR24 ABST0202 Suarez-Almazor @MDAndersonNews @RheumNow https://t.co/w58MNqRt1T
David Liew drdavidliew ( View Tweet)
Effective RA therapy is about more than just joints
🇪🇸 RA cohort
TNFi for first 24w led to:
Lean mass index i.e. muscle going up
Fat mass index i.e. fat trending down
Muscle & fat composition are important
Systemic Rx can deliver systemic benefits
#ACR24 ABST1348 @RheumNow https://t.co/mZjcHwxMgW
David Liew drdavidliew ( View Tweet)
Steroids in checkpoint inhibitor rheumatic irAEs need to be approached with caution.
Persistent higher doses earlier on might dampen ICI response.
@HSpecialSurgery ICI-IA (inflamm arthritis) cohort
big diff in survival based on early steroid exposure
#ACR24 ABST1989 @RheumNow https://t.co/3WAZ3ZLbFw
David Liew drdavidliew ( View Tweet)
Here's a meta-analysis of MACE/malignancy in JAKi vs TNFi in observational cohort studies.
All the epidemiological challenges here aside, it's a good reminder that with ORAL Surveillance it's *cardiovascular risk enriched pts* we're concerned about.
#ACR24 ABST2264 @RheumNow https://t.co/vIXlrI3V2d
David Liew drdavidliew ( View Tweet)
ACR 2024 - Day 2 Report
Plenary sessions began the day, followed by thousands on the abstract floor. Here are a few of my favorite presentations from day 2 at ACR 2024.
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RA patients on TOF with h/o ASCVD have 4x higher risk of MACE without statin (vs. TNFi).
Prioritize statins for heart health in RA!
#ACR24 @RheumNow ABST#1745 https://t.co/jRqXNU2T6d
Jiha Lee JihaRheum ( View Tweet)
The odds of axSpA patients developing fractures was lower among those on TNFi vs DMaRDs or NSAIDs accdg to this study by NGeorge et al.
axSpA pts are at high risk of fractures & drugs that mitigate these risks are important. More robust data are needed
@RheumNow #ACR24 abs1439 https://t.co/ZSV3og5N5x
sheila RHEUMarampa ( View Tweet)
A#1745
Post-hoc ORAL Surveillance - statin
<1/4 on a statin, only 53% h/o ASCVD on statin
Incr in LDL was less on Tofa pts on statin
Among those on b/l statins, there is no incr risk compare to TNFi, esp pts h/o ASCVD
If high risk on tofa, statin helps!
@RheumNow #ACR24 #ACRBest https://t.co/7MGgUk7tfI
Eric Dein ericdeinmd ( View Tweet)
In a cohort of >17,000 European pts w/ axSpA:
-bDMARD naïve pts starting TNFi or IL-17Ai were more likely to achieve LDA than TNF-experienced.
-Higher time to achieve LDA and shorter durability in pts with prior TNFi use.
Abst#1756 #ACR24 @RheumNow
Adela Castro AdelaCastro222 ( View Tweet)
Subgroup data from SELECT GCA, overall reinforces overall message
I was curious to see pts previously treated with TCZ; wonder if that selects for refractory phenotype - seems not to be the case
Take home: encouraging data, no subgroup issues
#ACR24 @RheumNow Abstr#1695 https://t.co/5iCLE6T4u3
Mike Putman EBRheum ( View Tweet)
Gonzalez Molina et al. MANHATTAN observational study. In PsA after 1st TNFi failure should we use guselkumab or 2nd TNFi? Guselkumab slightly better persistence, DAPSA, and improvements in joint counts. @RheumNow #ACR24 Abstr#1469 https://t.co/X3TMCVys6B https://t.co/vvkUYbzVDq
Richard Conway RichardPAConway ( View Tweet)
Gonzalez Molina et al. MANHATTAN observational study. In PsA after 1st TNFi failure should we use guselkumab or 2nd TNFi? Guselkumab slightly better persistence, DAPSA, and improvements in joint counts. @RheumNow #ACR24 Abstr#1469 https://t.co/X3TMCVys6B https://t.co/vvkUYbzVDq
Richard Conway RichardPAConway ( View Tweet)