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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Our reporters have been prolific in finding the hot abstracts, those that were most attended or those that are getting the most buzz on social media. Here are RheumNow's #ACRbest abstract reports from Monday, November 13, 2023 at #ACR23, covering The Great Debate, SGLPT2 inhibitors in SLE, the SMART Study of MTX, TMP/SMX Prophylaxis, RA-ILD & TNF Inhibitors, cancer research and more.
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Methotrexate is widely used in rheumatic diseases yet poses common tolerance issues, especially for the oral form; and bioavailability is known to be limited for doses over 15mg. In the SMART study, Prasad et al. present the first RCT comparing either single dose (25 mg) or split-dose (10 mg morning, 15 mg evening, same day) once weekly MTX for 24 weeks.
Eric Dein
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TM83 #ACR23 @RheumNow
45yo M b/l sacroiliitis, Rx MTX -> ADA -> MTX + Tofa. No improv
Low Ca, & Phos, ALP 239. Nml Vit D, High PTH.
DEXA: Osteoporosis
FGF23 high
PET/CT showed soft tissue density in nasal septum, few cortical breaks
Dx: oncogenic osteomalacia 2/2 malignancy https://t.co/EOcYNtovBy
Bella Mehta
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Extended-Release Fluticasone Propionate for Injectable Suspension - EP-104IAR
Phase 2 Randomized (1:1), Double-blind, Vehicle-Controlled Trial
318 pts, 57% F, age 64,
Clinically and statistically significant pain relief for 14 weeks compared to vehicle
@RheumNow #ACR23 #abstL04
David Liew
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If we're to summarize the challenges to making for CAR-T therapy work in a given disease, this is it:
Dr. Chyi-Song Hsieh @WUSTL #ACR23 @RheumNow https://t.co/raoHtrJ25S
Eric Dein
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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
Read my article on ACR Plenaries: Changing the Practice of Rheumatology #ACR23 @ACRheum @RheumNow @uptoTate @Yuz6Yusof @ericdeinmd
https://t.co/ql851dVzAk
Nouf Al hemmadi
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1-PJP prophylaxis or not in ANCA?
2-MTX single dose or split dose?
3-IL6 blocker early on in GCA/PMR?
4-SGLT2 in DM/Lupus nephritis?
5-Cervical cancer screening in Lupus?
6-TNF induced ILD?
https://t.co/mzGXajmQqE
@RheumNow , Daily recap
#ACR23
Aurelie Najm
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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
Robert B Chao, MD
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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
Dr. Antoni Chan
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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
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Two-week interruption of MTX for IMIDs enhanced boost of antibody responses after COVID-19 vaccination, sustained at 12, 26 weeks. Consistent across ages, MTX doses, route, IMIDs, primary vaccination platform,COVID-19, Abhishek A Abst#1677 #ACR23 @RheumNow https://t.co/T0KdsGh6vg
Aurelie Najm
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VROOM 🏎️ study
2 wks interruption of MTX just after COVID vaccine:
-Increase S1-RBD Ab response for 26 wks
-Improves Neutralizing Ab titres (Wuhan Hu-1)
-Leads to more flares wks 4 & 12
Greater effect when MTX dose>15mg
@RheumNow #ACR23 ABST1677 https://t.co/SJmaRHtbRH
Richard Conway
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Abishek et al. 2 week break from MTX enhances response to COVID-19 vaccination, mirroring what we saw for flu. Trade off is short term worsening of disease activity. Abstr#1677 #ACR23 @RheumNow https://t.co/gguRWER81x https://t.co/1hncvDTahH
Richard Conway
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Karpouzas et al. MTX reduces IHD in males but not females with RA. 4362 patients. 66% lower risk MACE and 55% lower risk any ischaemic CVE. Abstr#1627 #ACR23 @RheumNow https://t.co/MC4W0dinUv https://t.co/1hkBoawt4b
Aurelie Najm
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RA males 81% increase MACE & 58% ischemic CVE
2 folds Males>Females in MTX non users
Makes MTX users reduction 66% & 55% risk MACE & ischemic CVE and no diff w/ females
MTX use not assoc w/ reduction MACE in females
@RheumNow #ACR23 ABST1627 https://t.co/qbAc2bWdcM
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
Richard Conway
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SMART study - MTX split into morning and evening once weekly vs all together. 253 patients. Split dosing better efficacy (DAS28 4.1 vs 4.5, p=0.03), more LFT elevation but less neutropenia. Abstr#1583 #ACR23 @RheumNow https://t.co/tkrds4uqQP


