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Day 2 Report - ACR Plenaries: Changing the Practice of Rheumatology
Over the years of navigating the annual meeting, I found the sessions with the most impact to my practice were the Plenary Sessions. During these sessions, the latest research is presented, new ideas are floated, and old myths debunked. Here are the top ACR2023 Plenary abstracts I found impactful for my practice.
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IV Secukinumab for AxSpa
The FDA recently announced approval for intravenous secukinumab (Cosentyx) for adults with psoriatic arthritis, ankylosing spondylitis, and non-radiographic spondylitis. Data for this new approval will be presented at ACR Convergence on November 14th by Dr. Atul Deodhar.
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Wallace et al. Dose, duration, recency dependent relationship between GC and MACE. Even 5mg/day, 30 day use, and use 1 year prior associated with risk. 5mg, 7.5mg, 10mg pred for 90 days - 13%, 19%, 27% MACE increase Abstr#2430 #ACR23 #ACRbest @RheumNow https://t.co/50B5nGqxu9 https://t.co/lNrUbZOm0o
Richard Conway ( View Tweet)
A#2429 #ACR23 @RheumNow
ROMO v DEN - 12 mo RCT 70 GIOP pts at high-risk
Mean prednisolone dose 6.6 mg
H/o fragility fx in 1/2 pts
12 mo: Increase in spine BMD- ROMO (+7) and DEN (+2)
Hip and Femoral neck improved both (1.6% both), not signif diff bw grps
AEs: incr injxn site rxn https://t.co/VueuZIjFfM
Eric Dein ( View Tweet)
Who knew @FDA_Drug_Info presented #ACR23 posters?! I thought they just issue statements if there was information to be shared! Abst#1822 Bari and Toci use during the pandemic for #COVID19 did not show new safety signals. 1 case HBV reactivation with bari @RheumNow https://t.co/zd7TELsV2j
TheDaoIndex KDAO2011 ( View Tweet)
Important data re:ADVOCATE study and health related quality of life
Interesting question: is this due to AVA or just simply giving less steroids?
I discuss this on recent podcast: https://t.co/7Jm6ArFpsB
@RheumNow #ACR23 https://t.co/53T1p2Vvyb
Mike Putman EBRheum ( View Tweet)
Interesting counterpoint to a tweet from a few days ago re:black box warning for JAKs
No change in utilization rates post black box... maybe people had already baked this into the cake by then?
@RheumNow #ACR23 Abstr 2142 https://t.co/K9cWbRSWV6
Mike Putman EBRheum ( View Tweet)
#ACR23 Late-Breaking Abstr#L09 In a crowded market, you’ve got to stand out. Phase 2 RCT of LNK01001, a highly selective JAK1-i in China: improvement in ACR 20,50,70 vs PBO at WK12. Those in PBO who didn’t meet ACR20 improved after receiving Tx. Very low infections @RheumNow https://t.co/ZbJFNHOtFT
Md Yuzaiful Md Yusof ( View Tweet)
Great summary of the big takeaways yesterday at #ACR23. Always love talking to @KDAO2011 @EBRheum @RheumNow
We get into the use of MTX, the safety on TNFs and what is in the purview of rheumatology practice https://t.co/jm0a8ndrsi
Eric Dein ( View Tweet)
Excellent pragmatic RCT, TNF withdrawal in RA
Almost 2/3 flared by 1 yr; at 3 years up to 3 in 4
Supports my practice of generally continuing TNFs long term
Also highlights importance of pt preferences; 1 in 4 may do well if they wish to discontinue
@RheumNow #ACR23 #ACRBest https://t.co/G4l0DgBP2Z
Mike Putman EBRheum ( View Tweet)
#ACR23 Abs #2548 showed incidence rate of uveitis TEAEs was lower to Wk 16 in axSpA pts randomized to BKZ 160 mg Q4W vs PBO. https://t.co/kBLQnJbTU2 @rheumnow https://t.co/regYgvvCts
Dr. Rachel Tate ( View Tweet)
Age does NOT affect the chance of getting irAE or the severity when using check point inhibitors to treat cancer. Data from #CANRIO database in #Canada #ACR 23 @ACRheum @RheumNow #1063 https://t.co/bqbiXzdAqr
Janet Pope ( View Tweet)
Obs study, bDMARDs & malignancy
TNFi w/lower risk than ABA/RTX/IL6i & numerically lower than JAKs
I'm a little skeptical... KM curves diverged w/~45 days, seems implausible?
Agree w/first author, possible channeling bias
@RheumNow #ACR23 Abstr 1678 https://t.co/1uL3j6kTSj
Mike Putman EBRheum ( View Tweet)
Sendaydiego et al. Comparative cancer safety b/tsDMARDs. 37,026 patient database cohort study. Compared to TNFi, RTX HR 2.2 (1.5, 3.3) ABA HR 1.7 (1.3-2.4), JAKi HR 1.3 (0.9-1.9). Abstr#1678 #ACR23 @RheumNow https://t.co/bTNtaNJrln https://t.co/qQBM2F2q8N
Richard Conway ( View Tweet)
Ritux (OR 2.2), ABA (OR 1.3), JAKi (OR 1.3) significantly increase risk of cancer vs. TNFi
Cohort of 37000+ RA pts starting bio/tsDMARDs (379 incident cancers)
True biologic effect or confounding by indication in a generally more comorbid population?
@RheumNow #ACR23 ABST1678 https://t.co/suj6mVBEC0
Aurelie Najm ( View Tweet)
2 RA cohorts w/Breast Cancer
17% TNFi within 1yr after surgery
No diff in overall survival at 5 yr w/ TNFi or csDMARD
Trend towards better BC specific survival w/ TNFi vs. csDMARD only
Worst survival for GC>7.5mg/day
Only 2 yrs follow up
@RheumNow #ACR23 ABST1675 https://t.co/ekKlJ2dP5i
Aurelie Najm ( View Tweet)
Does TNFi use in pts with RA and early breast cancer affect survival?
TNFi did not affect overall survival or breast cancer specific survival compared to cDMARDs
Steroids did increase mortality
@RheumNow #ACR23 Abs#1675
Robert B Chao, MD ( View Tweet)
No significant difference in overall survival in early stage breast cancer (BC) patients treated with TNFi (alone -/+ cDMARDs, in 1st year of BC) and cDMARDs in RA. Those on glucocorticoids had worse survival. Suarez-Almazor M, Abst#1675 #ACR23 @RheumNow https://t.co/lnZx3OpuN5
Dr. Antoni Chan ( View Tweet)
There was a lower hazard ratio for incident cancer with exposure to TNFi compared to non-TNFi (RTX and ABA) and JAKi. Limits: potential for residual confounding by indication and small number of outcomes per drug class, Xavier S, Abst#1678 #ACR23 @RheumNow https://t.co/vJpFwl6Ivj
Dr. Antoni Chan ( View Tweet)
SMART study in RA, splitting MTX
Split dosing better at wk 16 but ~similar at wk 24
Caveat: wonky design from wk16-wk24 makes it hard to interpret?
Surprsingly, adverse events ~similar but smallish sample
Mostly supports my practice of splitting?
@RheumNow #ACR23 #ACRBest https://t.co/g7s4EUHeCW
Mike Putman EBRheum ( View Tweet)
