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Long live the GOAT Rx: MTX 🐐🐐
History of usage dating back to 1950
Use 1st-line
Optimize dose
Supplement folic acid
Split dose
Give SQ
Use in combination therapy
Dr Joel Kremer #RNL2023 @RheumNow https://t.co/CCBvQoNHXo
Eric Dein ericdeinmd ( View Tweet)
#ClinicalPearl #Methotrexate weekly May reduce side effects in rapidly dividing cells vs using it daily or every few days. GI, oral, bone marrow side effects should be less if once a week. Joel Kremer @RheumNow #RNL2023 https://t.co/i0LZoQuK0w
Janet Pope Janetbirdope ( View Tweet)
How is a biosimilar approved?
Comparative effectiveness study for the reason that the medication was initial approved required, not for other indications
Jonathan Kay shows ex of ETN-ykro vs reference ETN in RA
Non-inferior in immunogenicity, safety, efficacy
@RheumNow #RNL2023 https://t.co/OOHie9Qr5t
Eric Dein ericdeinmd ( View Tweet)
Was amazed at the tons of biosimilar TNF options @_connectedcare uses in Australia... coming soon to the US!
Jonathan Kay #RNL2022 shows the lists of biosimilar
May be w/in batch-to-batch variability, unintended drift, or deliberate process changes (evolution)
@RheumNow https://t.co/sfVQspxbyr
Eric Dein ericdeinmd ( View Tweet)
Jonathan Kay on #RNL2023:
Biosimilar is well-researched with cost savings
These savings should benefit the patients
Incentives for physicians as well in form of decreased prior auth burdens
@RheumNow
Eric Dein ericdeinmd ( View Tweet)
RBC MTX polyglutamate levels may be the “truth serum” for those pts stating they are taking their MTX but you question it. Dr. Kremer @RheumNow #RNL2023
Dr. Rachel Tate uptoTate ( View Tweet)
MTX is a prodrug!
MTX polyglutamate is true active ingredient
1/2 of MTX PG is 60 days, compared to only 6-8 horus for MTX
Steady state is not until 27.5 weeks!
Joel Kremer at #RNL2023 @RheumNow https://t.co/hodFZ2oi11
Eric Dein ericdeinmd ( View Tweet)
Do you stop MTX on patients on bDMARD?
MTX decrease anti-drug antibodies on patients on infliximab - increases drug duration.
Similar seen with new combination usage with pelogloticase
Joel Kremer MD
#RhuemNow @RheumNow https://t.co/8UrGZaFStA
Eric Dein ericdeinmd ( View Tweet)
How do you wean MTX?
Consider every other week dosing as options - supported by 2 randomized studies from 1995 and 1999
Option to lower weekly dosing in patients that want to take less often
Joel Kremer #RNL2023 @RheumNow https://t.co/3GMdn3lLhy
Eric Dein ericdeinmd ( View Tweet)
MTX lung disease:
Presents at 6-12 months
Baseline CXR is key to know if lung infiltrates are new
#RNL2023 @RheumNow https://t.co/Whu4O1GLA9
Eric Dein ericdeinmd ( View Tweet)
Do and don’t around MTX , Dr.Kremer approach to MTX #RNL2023 @RheumNow https://t.co/dXLQ0epsp4
Nouf Al hemmadi NoufAhmedAlham2 ( View Tweet)
@Janetbirdope at #RNL2023
RA is not a disease of young
Incidence increasing in elderly population, not often offered the full range of medications due to co-morbidities, despite safety data
Higher DAS, seroneg
Co-morbidities decrease outcomes
@RheumNow
Eric Dein ericdeinmd ( View Tweet)
Myths of RA by Dr. Janet Pope
- RA development should have ACPA years before?
- there is a significant minority of early RA patients who are seronegative!
@RheumNow #RNL2023 https://t.co/pnOxTkfW0l
Robert B Chao, MD doctorRBC ( View Tweet)
How much of RA risk is attributed to lifestyle?
@Janetbirdope presents Nurse's Health Study showing 35%
BMI and smoking increase risk of RA... in patients with ACPA positivity
#RNL2023 @RheumNow https://t.co/g9DIrgc7pk
Eric Dein ericdeinmd ( View Tweet)
@Janetbirdope #RNL2023
Benefit of intra-articular jt injections in early RA
Injection of 6-12 swollen joints (!) vs systemic glucocorticoids
-- FAR better ACR20 and ACR50 with less side effects
@RheumNow https://t.co/AtgCKOd8IC
Eric Dein ericdeinmd ( View Tweet)
Can we prevent RA, Kevin Deane #RNL2023 @RheumNow. https://t.co/EtUEs3MyCN
Nouf Al hemmadi NoufAhmedAlham2 ( View Tweet)
Upto 30% risk of #RA within 5 yrs if anti-CCP positive
#RNL23 https://t.co/E5wun837ud
Dr Gurdeep Dulay gurdeep_dulay ( View Tweet)
Stop RA trail:
Plaquenil didn’t prevent RA in patient with pre clinical RA. Kevin Deane #RNL2023 @RheumNow https://t.co/2Y5am2YEsQ
Nouf Al hemmadi NoufAhmedAlham2 ( View Tweet)
30% rule!
Risk of RA development in Pre clinical RA patient in the next 3 to 5 years .
Kevin Deane #RNL2023 @RheumNow https://t.co/J6Polz70im
Nouf Al hemmadi NoufAhmedAlham2 ( View Tweet)
#RNL2023 @RheumNow
There are a lot of RA Rx on market now - do we need more?
Dr. Brenner: YES
Stromal targets like LIF/LIFR, Notch3, cadherin-11 offer upstream benefits for our difficult to treat RA patients that don't respond to tradition cs/bDMARDs https://t.co/zJRRisGW9i
Eric Dein ericdeinmd ( View Tweet)
