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Babies! Safety and Outcomes Data on Pregnancies
EULAR Congress 2022 highlighted several posters on pregnancy, an important subject as most rheumatic diseases afflicts women during their childbearing years.
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EULAR 2022 – Day 1 Report
It’s good to be back into full, big meeting mode.
Highlights included a EULAR Recommendation Session, where updated guidelines were presented for the management of a) ANCA-associated Vasculitis, b) ASAS/EULAR recommendations for axSpA and c) RA. Here are a few of my favorites from Day 1.
A Big Leap in Modulating Rheumatoid Disease
Intervention in individuals predisposed to develop rheumatoid arthritis (RA), with a holy grail of prevention of RA, has long been a hot topic. It is well known that seropositivity for rheumatoid factor and antibodies to cyclic citrullinated peptides (ACPA) can precede RA disease by many years. Many, but by no means all, patients also seem to go through a pre-RA arthalgia phase of varying duration characterised by the presence of increasing joint pain without frank arthritis.
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Methotrexate plus leflunomide combination therapy for PsA treatment resulted in greater improvement in disease activity when compared to MTX monotherapy. As expected, MTX+LEF less well tolerated.
@RheumNow #EULAR2022 ABST#0078 https://t.co/Bo64QX3Bf9
Robert B Chao, MD doctorRBC ( View Tweet)
Study of 2.9k offspring exposed to adalimumab, infliximab, golimumab during pregnancy, as compared to etanercept and certolizumab showed an adjusted hazard ratio for serious infections of 1.20 (CI 0.54, 2.64).
@RheumNow #EULAR2022 ABST#OP0130
Robert B Chao, MD doctorRBC ( View Tweet)
No significant difference in malignancy risk in patients with rheumatic disease and a prior history of malignancy, who started bDMARDs or tsDMARDs. Interestingly IL-17i had 0 malignancy events and CD-20i were next lowest.
@RheumNow #EULAR2022 ABST#OP0138 https://t.co/Mq3YvOrSY8
Robert B Chao, MD doctorRBC ( View Tweet)
Does MTX have an impact on UST-immunogenicity in PsA?
Post-hoc analysis from UST RCT in 110+ pts
No difference in ADA rates & concentrations between
MTX and non-MTX groups and
ADA not associated w/ decreased UST levels
POS0079 @RheumNow #EULAR2022 https://t.co/TA0YTx8qRT
Aurelie Najm AurelieRheumo ( View Tweet)
#EULAR2022 ASAS/EULAR AxSpA Recs
⭐️Last: 2016
▶️All: education, exercise, 🚭
▶️❌csDMARD for axial disease
▶️TNF/IL17 (or JAK) with high disease: ASDAS>/=2.1
▶️Monoclonal TNF for uveitis/IBD, high PsO: IL-17
▶️Sustained remission: tapering of bDMARD "can be considered"
@RheumNow https://t.co/3yYU0Vb37r
Eric Dein ericdeinmd ( View Tweet)
Proof that MTX doesn't affect sperm! Sperm morphology, motility, concentration, semen volume, testosterone/LH/FSH similar b/f and after exposure; DNA fragmentat'n was⬆️in pre-MTX exposure (possible reason high dz activity contributes to infertility) #EULAR2022 @rheumnow OP0131 https://t.co/JWLEggRhAY
TheDaoIndex KDAO2011 ( View Tweet)
Hamroun @annamolto et al. Factors assoc with increased time to conception in SpA. 56 pregnancies. Multivariate model, age (HR 1.22 (1.08-1.40)) and preconception NSAID use (HR 3.01 (2.15-3.85)) assoc increase time to conception. @RheumNow #EULAR2022 OP0153 https://t.co/y2EAyAdRmk https://t.co/28aLimRInE
Links:
Richard Conway RichardPAConway ( View Tweet)
Perez-Garcia et al. MTX effect on semen parameters. I still frequently get queries about this. 48 participants here. No significant effect! @RheumNow #EULAR2022 OP0131 https://t.co/33NG6isehm https://t.co/g7Xn33i96u
Links:
Richard Conway RichardPAConway ( View Tweet)
Patient with 12 weeks inflamm-sounding arthralgias and functional impairment, high titre RF/CCP, osteitis on MRI, no clinical synovitis on exam.
Do you suggest to patient to treat with methotrexate?
#EULAR2022 @RheumNow
David Liew drdavidliew ( View Tweet)
🚨 Study on MTX and male fertility
Analysis of semen parameters in
🙋🏼♂️HC
🙋🏼♂️RA, PsA and PsO MTX naive
🙋🏼♂️Post MTX
Reassuring data as NO significant effect of MTX was observed on several semen parameters.
#EULAR2022 @RheumNow
OP0131 https://t.co/Fq32lzAMAx
Aurelie Najm AurelieRheumo ( View Tweet)
Hamroun S et al for the GR2 Cohort showed that age HR 1.22 and use of NSAIDs HR 3.01 in the pre-conception period was associated with a longer time to conception in women with SpA. Research is needed on continuous NSAID use in the preconception period #EULAR2022 @RheumNow OP0153 https://t.co/hl6jUlK5PN
Dr. Antoni Chan synovialjoints ( View Tweet)
MIRACLE study: High or Low dose MTX w/ ADA in eRA?
✨ LOWd (6-8mg/w) 38.4% non-inferior to HIGHd (>10mg/w) 44.8%
✨But safety profile looks better 9.1% vs 22.1% 👀
Are you already looking for minimal dose of MTX in patients treated w/ biologics?
#OP0062 @Rheumnow #EULAR2022 https://t.co/dq0EIKSnOe
Aurelie Najm AurelieRheumo ( View Tweet)
6 psoriatic disease specific risk factors associated with incident cardiovascular events in PsA/PsO patients: PsO area, TJC, SJC, HAQ score, ESR, daily use of NSAIDs
@RheumNow #EULAR2022 #ABSTOP0030
Robert B Chao, MD doctorRBC ( View Tweet)
NORD-STAR substudy of coagulation and fibrinolytic parameters:
〽️Impairement in eRA
⚡️Biologic parameters restored by ttmt.
Effect seemed ▶️ with Biologic vs. MTX + GCs
❕No adjustment on disease activity #OP0059 #EULAR2022 @RheumNow https://t.co/CJHldOimBn
Aurelie Najm AurelieRheumo ( View Tweet)
Cdn cohort of #PsA and CV events - u risk factors were associated with MACE and NSAIDS ⬆️ risk and TNFi ⬇️risk and poor HAQ⬆️ risk. #OP0030 @RheumNow @eular_org Too small events, lipids often absent and spanning 30+ yrs.
Janet Pope Janetbirdope ( View Tweet)
Once we add adalimumab in MTX-IR RA, can we dial down MTX & still keep control?
New data - now in East Asian pts (with already low MTX) says often yes, without ⬆️ADAb.
Obviously RA control 1st/2nd/3rd, but prob doesn’t have to be MTX 20 forever in everyone #EULAR2022 @RheumNow https://t.co/aZ0bsgY7dC
David Liew drdavidliew ( View Tweet)
Pre-clinical RA TREAT EARLIER Trial: #Plenary OP0070
RDBPCT eval temporary MTX vs PCB in 136 pts with arthralgias >2 weeks at risk for RA (MRI hand/forefoot w/subclinical inflammation) followed for 2 yrs; 1/3 +ACPA. Rx 1 yr can delay but won’t prevent RA. #EULAR2022 @rheumnow https://t.co/v1GWOBFstz
TheDaoIndex KDAO2011 ( View Tweet)
