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In Brazil, if you’re in the early RA clinic (yellow bars) you do a lot better than other academic clinics, even w bDMARD access.
Maybe it’s early Rx, or love & care, or other patient factors
- but it’s a reminder that RA isn’t a level playing field.
POS0055 #EULAR2023 @RheumNow https://t.co/jI2dvuIHWP
David Liew drdavidliew ( View Tweet)
Tapering pred in RA - this just rings true from everyday clinic life.
Some patients just seem to hit a wall at PNL 2.5. Sometimes it’s GC withdrawal arthralgias/tertiary adrenal insufficiency, but often it’s genuine inflammation.
I still wonder why?
POS0050 #EULAR2023 @RheumNow https://t.co/JBh26VqPuM
David Liew drdavidliew ( View Tweet)
Can machine learning help bDMARD selection in RA?
Early days limited by the data available, so not great yet, but efforts underway are a good start for an area where we need to do better than our status quo guessing.
Watch this space
POS0641 #EULAR2023 @RheumNow https://t.co/2j8H40iFWo
David Liew drdavidliew ( View Tweet)
TNFi & Disease activity-guided dose optimization in RA⬇️prog of ADA or ETA daily dose (100%66%50%0%)
10yrs followup in 170pts
⭐️74% tapered until full discontinuation
⭐️Median time to restart 8 mo
⭐️21% never restarted!
What's lacking? % of recovery
@Rheumnow OP0131 #EULAR23 https://t.co/Ms6lqQ7cWf
Aurelie Najm AurelieRheumo ( View Tweet)
Rituximab in RA - do you need to maintain B cell depletion?
Well, in this Paris cohort, if you divide up patients by B cell depletion (at time of next infusion) - no diff in efficacy.
Bias possible but B cell depletion in RA isn’t the hill to die on POS0636 #EULAR2023 @RheumNow https://t.co/GLdu9YkL7g
David Liew drdavidliew ( View Tweet)
CareRA trial:
3 months addition of LEF vs. ETA in pts resistant to COBRA-Slim regimen (MTX 15 mg/w + step-down prednisone):
After 2 years, no difference in dis control but those who received ETA early were treated more frequently w/ csDMARD monotherapy #EULAR23 @RheumNow OP0129 https://t.co/YwSoZWi375
Aurelie Najm AurelieRheumo ( View Tweet)
Don’t be ‘rash’, get adult immune compromised Pts vaccinated against #shingles #varicella #zoster K Winthrop has research re #HZ #vaccination with #Shingrix in #Upadacitinib at #EULAR2023 #OP0225 Bottom line-get #immunecompromised Pts with #rheumatoidarthritis jabbed! @RheumNow
Janet Pope Janetbirdope ( View Tweet)
“You don’t need MTX with TCZ for RA”
Err, well:
- just like TNFi, you def can get ADAb to TCZ
- they definitely lead to lower response rates
- MTX co-admin reduces ADAb
Seems like a good idea to me, but your call 🤷♂️
Bitoun, Mariette et al POS0630 #EULAR2023 @RheumNow https://t.co/2jOAqA6YZ3
David Liew drdavidliew ( View Tweet)
The risk of demyelination with TNFi is low but real. Slight increase of risk was found in male RA patients. The small number of events is reassuring. Careful consideration is recommended in individuals at highest risk of demyelinating diseases Abst#OP0135 #EULAR2023 @RheumNow https://t.co/YT6ZrJTjU0
Dr. Antoni Chan synovialjoints ( View Tweet)
In polyrefractory RA patients, half did not have any PDUS change on ultrasound and/or had normal CRP levels, showing that in the other half, new mechanisms of action for treatment is required by David P, Abst#OP0134 ##EULAR2023 @RheumNow https://t.co/TaY7uGU0bg
Dr. Antoni Chan synovialjoints ( View Tweet)
No relationship between MTX-PG levels in terms of efficacy by SDAI remission but higher MTX-PG levels related to adverse events by Tamai H, Abstr #OP0128 #EULAR2023 @RheumNow https://t.co/TiO5eeYlnS
Dr. Antoni Chan synovialjoints ( View Tweet)
We’re getting better at understanding different types of refractory RA (D2T RA)
We see differences with refractory RA subtypes:
PIRRA (persistently inflamm on USS), and
NIRRA (non-inflamm)
hopefully moving to data-driven Rx approaches for D2T RA?
OP0134 #EULAR2023 @RheumNow https://t.co/vX5IK5O9Wm
David Liew drdavidliew ( View Tweet)
Difficult to treat #rheumatoid #arthritis is a grab bag of multi drug failures or intolerant with high or LOW disease activity 3 groups and diff reasons for failure and diff risk factors. ? Sunset the D2T Pts? OP0117 #EULAR2023 @RheumNow @eular_org https://t.co/1qPMq32kVz
Janet Pope Janetbirdope ( View Tweet)
The overall risk of cancer and cardiovascular disease were decreased in RA treated with JAKi but there was no comparison with TNFi, Sung Soo Ahn, Abst#00132 #EULAR2023 @RheumNow https://t.co/9Bi6t6uuig
Dr. Antoni Chan synovialjoints ( View Tweet)
Biologic dose reduction based on disease activity resulted in 40% reduction in TNFi and did not seem to cause disease deterioration from the 10 year DRESS Study by N van Herwaarden, Abst#OP00131 #EULAR2023 @RheumNow https://t.co/ncGPF9ODcF
Dr. Antoni Chan synovialjoints ( View Tweet)
Abatacept use in individuals at risk of RA reduced the rate of progression to RA during the treatment phase and împrovement in clinical symptoms over 2 years in the APIPPRA trial by Cope A, Abstr#OP0130 https://t.co/k0SFDHBRE9
Dr. Antoni Chan synovialjoints ( View Tweet)
#JAKi May decrease #cancers - age, male, #diabetes had more #cancer but NOT associated w drug prescribed AND LESS #malignancy & LESS #CVE in JAKi vs csDMARDs in huge admin database. Diff from other results OP0140 @RheumNow #EULAR2023 EFFECTIVE Rx of RA LOWERS CVE & cancer w JAKi! https://t.co/oQ3QeUZz3E
Janet Pope Janetbirdope ( View Tweet)
Get Un ‘DRESSED’? Use of #etanercept or #adalimumab for #rheumatoidarthritis. #RCT of dose optimization-observational f/u over 10 yrs with attempts to lower and even d/c Rx in #RA You CAN lower dose in many Pts & even d/c Rx and recapture. X-rays OK @RheumNow #EULAR2023 #OP0131 https://t.co/PGK5SQJ1WU
Janet Pope Janetbirdope ( View Tweet)
As Jack himself pointed out - we’re looking at patients without loads of inflammation. For me, to get anything out of this population is very interesting. Adding this to ARIAA, it does make us think about which pre-RA might benefit from abatacept, and how.
#EULAR2023 @RheumNow https://t.co/UKHfc1X8QM
David Liew drdavidliew ( View Tweet)
What’s more - if you have arthralgias and more autoantibodies than just ACPA IgG, then maybe abatacept might actually make a substantial difference. There is prob a population in whom abatacept substantially prevents RA developing.
Is it safe? ⬇️
APIPPRA #EULAR2023 @RheumNow https://t.co/94Y7HrBuEp
David Liew drdavidliew ( View Tweet)
