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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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#ACR BEST Abstracts from San Diego – Day 1
The RheumNow faculty reporters have been scouring the meeting for what they believe to be the best presentations from the first day at ACR 2023 in San Diego. From hundreds of online presentations, the poster floor and the plenary podium, here are some of the best abstracts from Sunday Nov. 12th. You can spot these on Twitter by looking for the (#ACRbest) hashtag.
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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)
Large VA study of >1k RA-ILD pts
No difference in risk of respiratory hospitalization or death in RA-ILD pts using TNFi vs. nonTNFi/JAKi
Data does not support avoiding TNFi in RA-ILD
@RheumNow #ACR23 Abs#1582 https://t.co/LTNLXEIAPo
Robert B Chao, MD ( View Tweet)
Important plenary session, RA-ILD outcomes in VA cohort study
No difference in death/hospitalization for TNF vs non-TNF treated patients. Jives w/my priors; I do NOT avoid TNF in RA-ILD
Encouraging if you (like me) prefer RA-active tx for RA-ILD 😉😆
@RheumNow #ACR23 #ACRBest https://t.co/TIDzMLOfs4
Mike Putman EBRheum ( View Tweet)
Glucocorticoids-free zone in SLE?
For over 70 years, glucocorticoids, (GC) have been a part of standard therapy in SLE. They are classically used to not only induce remission or treat an acute flare, but also as maintenance therapy. #ACR23
https://t.co/sfRhNj6OpZ https://t.co/k6VoG5lKO7
Dr. John Cush RheumNow ( View Tweet)
To remind us. Glory be! GLORIA a #RCT in elderly active #RA: MTX+10 mg daily #prednisolone which was better than MTX alone. But more infections and no comparison of inexpensive Rx such as adding #HCQ. Still debated as to benefit vs risk of this strategy @RheumNow #ACR23 @ACRheum https://t.co/slOmESbIOW
Janet Pope ( View Tweet)
Super interesting study re: impact of ORAL SURVEILLANCE on prescribing
Post safety report, JAK pts shifted younger w/lower comorbidities (esp CVD)
I know many have mixed feelings, but I believe in the risk & support this type of shift
@RheumNow Abstr0435 #ACR23 https://t.co/EBg9VOIbj1
Mike Putman EBRheum ( View Tweet)
No more underpowered long-term safety studies
We need a "SELECT-SURVEILLANCE" study to replicate ORAL-SURVEILLANCE & tell us if UPA has the same MACE/cancer risk as TOFA
Minus that, I plan to go 100% TOFA when it becomes generic in 2026
@RheumNow #ACR23 Abstr1326 https://t.co/LyQ1Q8qReO
Mike Putman EBRheum ( View Tweet)
