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Stopping therapy in GCA
They say the easiest bit about GCA, like PMR, is the first week after you start steroids. Those fond memories belie the challenge of ongoing treatment in GCA. In a steroid-only world, there is only misery. Steroid-sparing therapies have changed this completely.
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Prospective RCT on safety & efficacy of TAC+GC vs. MMF+GC
TAC+GC was comparable to MMF+GC as continuous induction maintenance treatment over 96 wks for LN.
AE rates comparable.
TAC - AKI & tremor
MMF - leucopenia
reassuring data.more tx options.
#ACR25 @RheumNow Abs2697 https://t.co/16Fd8zE5dL
sheila RHEUMarampa ( View Tweet)
LB04: Another approach to CAR-T, CD20+/BCMA bispecific CAR-T in refractory proliferative LN:
🔹100% discontinued biologics & IS at follow-up
🔹Renal response ~78%
🔹CRS mostly Grade 1–2 (~70%); ≥Grade 3 AEs = transient & hematologic
@RheumNow #ACR25 https://t.co/oNK4wtLGYV
Links:
Akhil Sood MD, MS AkhilSoodMD ( View Tweet)
Another toxicity signal to watch in the CAR T space: LICATs
Abstract 1537 reports a new immune-related toxicity distinct from CRS or ICANS:
🔹Affects organs prev involved in autoimmune dx: skin (35%) and kidneys (22%)
🔹Mostly mild (Grade 1–2); 3 cases Grade 3
@RheumNow #ACR25 https://t.co/mtZh47nWtv
Akhil Sood MD, MS AkhilSoodMD ( View Tweet)
#SLE #DORIS #remission is RARE and without #prednisone even rarer
#ASIA #Pacific 5K pts over 10 yrs
A call to do better
82% LLDAS, 70% remission, 31% GC-free remission (REM-0) at least once
abst#595 @ACRheum @RheumNow
#ACRBest https://t.co/OK6sYnqs81
Janet Pope Janetbirdope ( View Tweet)
What to use in future for active #Sjogren's #SjD
B cell depletion, signal attenuation
Ianalumab 2+ phase3 RCTs
Telitacept +RCT
Nipocalimab FcRn +Ph2
Dazodalibep CD40L +Ph2
+RCTs
HCQ+Lef
Rituximab
?BTKi
#ACR25 @ACRheum @RheumNow
abst#LB24, LB11
Janet Pope Janetbirdope ( View Tweet)
#MTX is NOT the same as TCZ in #GCA in RCT
#TCZ did better
So use an advanced Rx for GCA
ex TCZ, Upa when approved
METOGiA RCT - more relapses in MTX
abst#891 #ACR25 @ACRheum @RheumNow https://t.co/wsEKGF8dW2
Janet Pope Janetbirdope ( View Tweet)
When should you order a renal bx in suspected #LN?
Active urinary sediment
Used to be #UPCR 500g/g or more
Abst#772 looked at UPCR 250g/g to 499
71% + LN and half needed Rx
esp if
Low C3,C4
Black race
Petri, Baltimore #lupus #cohort
#ACR25 @ACRheum @RheumNow
Janet Pope Janetbirdope ( View Tweet)
#Ianalumab decreases disease activity in active #Sjögren's #disease
2 phase3 DB #RCT added to #SoC in primary #SjD
>90% #Ro+
+#ESSDAI in monthly sc dosing vs placebo,
Many 2ndary outcomes improved, safe
LB#24 #ACR25 @ACRheum @RheumNow
#ACRBest https://t.co/Z4ooUg7Nos
Links:
Janet Pope Janetbirdope ( View Tweet)
TAC+MMF + GC vs TAC +GC in lupus nephritis (target trial emulation):
🔹Higher total renal response w/ TAC + MMF + GC at 12 mo (59.7% vs 33.3%) consistent in ITT & per-protocol
🔹similar adverse events reported (14.6% vs 16.4%)
@RheumNow #ACR25 https://t.co/Yuql3O9C8X
Akhil Sood MD, MS AkhilSoodMD ( View Tweet)
#ACR25 Abstr#2695 Inguinal lymph node biopsies pre- and post-OBI, RTX, BLIN & CD19 CAR-T showed complete tissue depletion with CAR-T. B-cells reduced but often incomplete with protein-based depleters; OBI being the best. Still don’t agree with “immune reset” @RheumNow #ACRBest https://t.co/Sq7m9sXlLP
Links:
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
#2682 In a randomised trial of 320 RA patients, the recombinant zoster vaccine (RZV) was safe and did not trigger disease flares. But methotrexate use and older age significantly blunted antibody responses ➡️key factors to consider for vaccine strategies in RA. @RheumNow #ACR25
Mrinalini Dey DrMiniDey ( View Tweet)
kids w
👇
Undifferentiated #systemic #autoinflammatory #disease
Rx #IL1i
N=33
=boys &girls 3.5 yrs Sx
Abst#2151
#ACR25 @ACRheum @RheumNow
There are many periodic fever syndromes
🤔some mutations are not yet discovered
Access to &use of
Anakinra
canukinumab
Rilonacept https://t.co/IyTx0nFxKC
Janet Pope Janetbirdope ( View Tweet)
#2659 In a large real-world target trial (>1.3M with T2D), SGLT2 inhibitors, esp dapagliflozin & empagliflozin, were assoc with lower risks of RA, lupus, vasculitis & other autoimmune rheumatic diseases vs DPP-4 inhibitors. Possible immune benefits of SGLT2i? @RheumNow #ACR25
Mrinalini Dey DrMiniDey ( View Tweet)
Abstract 2697: Compared to MMF, tacrolimus showed
- similar SRR by week 96 (58.5% vs. 69.2%, OR 0.62; 95% CI 0.29-1.29)
- similar time to renal AE/deaths (HR 0.70; 95% CI 0.37-1.35)
- serious AEs less frequent (12.3% vs. 30.8%)
@RheumNow #ACR25 https://t.co/o3LtgOp7St
Akhil Sood MD, MS AkhilSoodMD ( View Tweet)
#ACR25 Abstr#2697 H2H RCT of Tacrolimus + GC vs MMF + GC in #lupus Nephritis in Asia for Induction-Maintenance showed similar efficacy. Different side effects: AKI more in TAC, low WCC & infections in MMF. Informative for services with no access to biologics/Voclosporin @RheumNow https://t.co/V4uWhuqjjW
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
#2658 In >870k adults with T2DM or obesity, GLP-1 receptor agonists showed no increase in autoimmune or inflammatory disease risk, and were instead linked to lower mortality, heart failure, stroke and dementia. Excellent real-world safety signals. @RheumNow #ACR25
Mrinalini Dey DrMiniDey ( View Tweet)
Abstract 2695: Deep dive into B-cell depletion (BCD)
Lymph node biopsy pre/post tx:
🔹 CAR T: complete BCD + disrupted follicular architecture
🔹 RTX, OBI, BLIN: reduced BCD + preserved follicular architecture
✅ Complete LN depletion → drug-free remission
@RheumNow #ACR25
Akhil Sood MD, MS AkhilSoodMD ( View Tweet)
Year in Preview
SLE: 52% subtherapeutic on weight based HCQ dosing
Precision prescribing needed, more so for CKD
@RheumNow #ACR25 Abstract 1722 https://t.co/8WqorQ1xJx
Jiha Lee JihaRheum ( View Tweet)
Hydroxychloroquine in SLE is all about the sweet spot. Not too hot with retinopathy, not too cold with flares, just right by the levels.
Yet drug concentrations and TDM are not commonplace in many places - time for change
Laura Coates in the #ACR25 meeting review @RheumNow https://t.co/oB3ecfSQQc
David Liew drdavidliew ( View Tweet)
