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An update on JAK inhibitors and cardiovascular risks
In the last 2 years, there has been more caution and vigilance with the use of JAK inhibitors in the treatment of rheumatoid arthritis due to the risk of CV events, including MACE and VTE. The ORAL surveillance study, a post-approval safety study conducted in RA patients aged ≥50 years with ≥1 CV risk factor, has resulted in increased caution and greater emphasis on assessment of MACE and VTE risks in patients starting JAK inhibitors.
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ILD in RA and PsA
Interstitial lung disease (ILD) is a severe extra articular manifestation of RA, with limited treatment strategies and poor prognosis.
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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)
Well certainly, despite the absence of synovitis, these pre-RA patients felt better on their 12m of abatacept. They could do more and hurt less.
That does count for something for many patients.
But wait, there’s more ⬇️
#EULAR2023 @RheumNow https://t.co/3naNdWGMuX
David Liew drdavidliew ( View Tweet)
Abatacept for 12m in ACPA pos arthralgias probably doesn’t impact RA progression that much once the abatacept stops…
but are there other reasons you might want to give it? Read on in the next tweet⬇️
APIPPRA study #EULAR2023 OP0130 @RheumNow https://t.co/68CViUeWHy
David Liew drdavidliew ( View Tweet)
How much MTX do we need with adalimumab in RA? Can blood concentrations help?
MTX RBC polygluts:
- don’t seem to match to efficacy
- do seem match to safety, a bit
(no ADAb data here)
*One day* we’ll get better at what MTX dose is needed with TNFi #EULAR2023 OP0128 @RheumNow https://t.co/OGM3hxr4fG
David Liew drdavidliew ( View Tweet)
#EULAR2023 #OP0007 What are the recent trends of autoimmune disease (AID)? A database study (22m) in UK showed:
- 1 in 10 people had AID in the last 20yrs
- socioeconomic, seasonal & regional disparities cd influence pathogenesis
- CTD (SLE,pSS,SSc) tended to co-occur @RheumNow https://t.co/3DDPR2K5NC
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
A highlight at #EULAR2023 AI in predicting RA from MRI scans of hands and feet in patients with early onset arthritis or clinically suspect arthralgia. From 1,974 people, 651 went on to develop RA. The accuracies were close to expert level prediction, Li Y, Abst#OP0002 @RheumNow https://t.co/MP8yn18PWI
Dr. Antoni Chan synovialjoints ( View Tweet)
Beydon et al., french registry study 255000+ RA patients 2010-2020
Increase ⬆️ overall malignancy by 20% vs. general pop
⬆️lung 40%, ENT 40%, cervix 80%, prostate 8%, melanoma 37%
Pancreatic cancer 10% less frequent in ♂
Breast 9% & Uterine body 23% less frequent in ♀
Aurelie Najm AurelieRheumo ( View Tweet)
So can computers beat humans in predicting RA from pre-RA arthralgia MRIs?
No, for now… but unsupervised they pick up the same culpable features we look for: bone marrow edema & tenosynovitis. Sometimes it’s nice when the machines tell us we’re right
#EULAR2023 OP0002 @RheumNow https://t.co/71Zo2JyC8d
David Liew drdavidliew ( View Tweet)
I swear it is muscle, Doctor!
GLORIA trial substudy
Pred 5 mg/day 2 years in RA pts >65yo:
Weight gain 1kg vs. PBO, no increase or redistribution of fat mass but augmentation in lean mass 💪
Probably explained by better disease control (although NS in study, small sample size)
Aurelie Najm AurelieRheumo ( View Tweet)
EULAR PtoC management of targeted therapies in pts w/ IA & Hx cancer
1) If remission, initiate targeted therapy w/out delay
2) Prefer anti-cytokine bDMARDs if Hx solid cancer
3) B cell depleting therapy if Hx lymphoma
4) Use JAK inhibitors and abatacept with caution 🛑 https://t.co/cKhQVZwGh1
Aurelie Najm AurelieRheumo ( View Tweet)
Prediction of RA early arthritis & clinically suspect arthralgia pts w/ AI analysis of MRIs scans:
✔️Feasible
✔️Accurate AUC 0.683 EA group AUC 0.727 CSA group
✔️Peformance = human experts
✚ Could identify new imaging biomarkers
https://t.co/sVXw9A8NqZ OP0002 #EULAR23 @Rheumnow https://t.co/oq5RJApm9U
Links:
Aurelie Najm AurelieRheumo ( View Tweet)
Provan et al. large scandinavian registry study: 🫁ILD risk in RA & PsA initiating b/tsDMARDs
HR ILD RA=10
HR ILD PsA=5
No increase risk w/ MTX and b/tsDMARDs but RA HR ILD 1.7 RTX vs. ETA: confounding by indication?
https://t.co/CF1ysNkQxU OP0006 #EULAR23 @Rheumnow https://t.co/DgDE1uFeUs
Links:
Aurelie Najm AurelieRheumo ( View Tweet)
