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ACR 2024 - Day 2 Report
Plenary sessions began the day, followed by thousands on the abstract floor. Here are a few of my favorite presentations from day 2 at ACR 2024.
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JAKi in inflammatory myositis?
Abstract 1731 is a small RCT of baricitinib in inflammatory myositis comparing early start baricitinib to later start.
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Upadacitinib in Behcet's disease - would be very much welcomed, and this open label 8 patient pilot from China is encouraging.
We saw similar data for tofacitinib before @ARD_BMJ: https://t.co/YlAQVXpnTY
JAKi (?generic) could be a fantastic option!
#ACR24 ABST2515 @RheumNow https://t.co/65friNLUOK
Links:
David Liew drdavidliew ( View Tweet)
Here's a meta-analysis of MACE/malignancy in JAKi vs TNFi in observational cohort studies.
All the epidemiological challenges here aside, it's a good reminder that with ORAL Surveillance it's *cardiovascular risk enriched pts* we're concerned about.
#ACR24 ABST2264 @RheumNow https://t.co/vIXlrI3V2d
David Liew drdavidliew ( View Tweet)
We saw evidence for JAK use in GCA this conference... what about IL-1 inhibition?
Double-blind RCT: Anakinra vs. PBO w/ similar GC taper in GCA pt
NO difference in relapse rate at 26, 52 wks despite addition of Anakinra
@RheumNow #ACR24 Abst1699 https://t.co/gUb0gGJjTG
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
Super helpful results from COVER study, holding JAK or IL17 for COVID boosters Antibody titers went up regardless of holding Holding caused flares (14-25% increase!) Pretty clear message; continue JAK / IL17 #ACR24 @RheumNow Abstr#1718 #ACRbest https://t.co/Mf89dWrRWz
Mike Putman EBRheum ( View Tweet)
Comparison of infection risk across b/tsDMARDs in IA in real-world study
Treatment with
➡️Rituximab
➡️JAKi
➡️Anti-IL6
assoc with ⬆️⬆️ risk of severe infection compared to TNFi
A reminder to consider comorbidities & infection risk in selecting b/tsDMARDs
Ab1716 #ACR24 @RheumNow
Mrinalini Dey DrMiniDey ( View Tweet)
Interesting comparative effectivness study, TOFA vs calcineurin inhibitors in MDA5-dermato
Expansion of prior publication @NEJM that used historical controls: https://t.co/AzA8ybCqYH
Encouraging data for JAKs in this disease; need proper trials
#ACR24 @RheumNow Abstr#1736 https://t.co/BHVMZLu6Ip
Links:
Mike Putman EBRheum ( View Tweet)
Wu et al. MDA5-DM. Propensity-score cohort study. 672 patients. Tofacitinib vs CNI. Primary outcome 1 year death or lung transplant. HR 0.70 favouring tofacitinib. @RheumNow #ACR24 Abstr#1736 https://t.co/A0aHhp1q9c https://t.co/LbutJDBllr
Links:
Richard Conway RichardPAConway ( View Tweet)
Chinoy et al. Baricitinib in IIM. Delayed-start clinical trial. 15 patients. 14/15 improved at 24 weeks (the other withdrew). 50% vs 100% at week 12 (delayed start group initiation). Stats confuse me a bit here but promising. @RheumNow #ACR24 Abstr#1731 https://t.co/orewsxbPpL https://t.co/5AyRpYJdec
Links:
Richard Conway RichardPAConway ( View Tweet)
#Upadacitinib rises ‘ Up’ in all subgroups of #GCA Subset of overall #RCT of #rinvoq w more reduction of #steroids vs placebo+ slower #prednisone taper Consistent results best in UPA 15 mg >UPA 7.5mg/d > #placebo #ACR24 #ACRBest @RheumNow @ACRheum abst#1695 https://t.co/dA7RkNmWFd
Janet Pope Janetbirdope ( View Tweet)
Alright help me out here; this is pretty implausible, right?
Why would be pts be 11% more adherent to UPA? What's the bio-plausibility here? UPA 10% better than other JAKs?
Could do a network meta analysis; betting this doens't replicate
#ACR24 @RheumNow Abstr#1362 https://t.co/vpPq3vu9Wf
Links:
Mike Putman EBRheum ( View Tweet)
No Increase in Cardiovascular Events with JAK Inhibitors in IBD Patients
UMKC researchers have compared the use of JAK inhibitors versus tumor necrosis factor (TNF) blockers in inflammatory bowel disease (IBD) patients, but failed to see an increase in major adverse… https://t.co/IOzckJIfYf https://t.co/8S6FnffVLG
Dr. John Cush RheumNow ( View Tweet)
TYK2/JAK1 in Dermato? Interesting pre-clinical study of brepocitinib... but we really just need clinical data
Glad to see this is headed straight to a Phase 3! Hoping they allow IVIG: has been a problem with many/most/all? recent dermato studies
#ACR24 @RheumNow Abstr#0882 https://t.co/KS8fTMBpPR
Mike Putman EBRheum ( View Tweet)
In this large 🇦🇺 RA cohort, median time on treatment for upadacitinib was lot higher than other JAKi
(28mo vs 17mo)
Why?
Patient selection, or a real difference between JAKi?
Would really like more comparative effectiveness data between JAKi
#ACR24 OPAL group ABST1370 @RheumNow https://t.co/OU2ayzqIc8
David Liew drdavidliew ( View Tweet)
Spicy network SRMA, 123pts w/JAK-TNF-PLBO
TNF >> JAK w/respect to malignancy (expected) & better than PLBO (spicy!)
JAK > PLBO for heme cancers (makes sense); no significant (but slight trend) toward PLBO > JAK for all cancer
The debate continues
#ACR24 @RheumNow Abstr#0989 https://t.co/tBnb02gyzF
Mike Putman EBRheum ( View Tweet)
Which RA patients are at increased risk of JAKi adverse events? Does disease activity matter?
in the upadacitinib ph3 trials, high disease activity pts had more:
serious infections
HZ
MACE
VTE
Active RA is a massive contributor to many AEs in JAKi pts
#ACR24 ABST1393 @RheumNow https://t.co/DlFf9Sfbja
David Liew drdavidliew ( View Tweet)
Gottlieb et al. TYK2i Zasocitinib in PsA. 12 week phase 2 RCT. Skin responses and MDA all favour zasocitinib but maybe not fantastic? PASI75 46%, PASI90 37%, PASI100 26%. MDA in photo. @RheumNow #ACR24 Abstr#1477 https://t.co/iX5iriESV2 https://t.co/RkEmcAZ80x
Links:
Richard Conway RichardPAConway ( View Tweet)
Slick poster, but must be careful w/real world data. Big risk of confounding/channeling bias
Pts with MACE risk (not always well-characterized by ICD codes) also less likely to receive JAK & therefore less liekly to have subsequent MACE
#ACR24 @RheumNow Abstr#1394 https://t.co/lilU0byJ1s
Mike Putman EBRheum ( View Tweet)
Getting more data on using deucravacitinib for PsO/PsA manifestations
Impressive effect on scalp psoriasis (which often means a lot to patients)
Given how safe it is, it's increasingly tempting to use more of it in mild-mod PsA
#ACR24 PSORIATYK SCALP trial ABST1137 @RheumNow https://t.co/vxS3RSlIN0
David Liew drdavidliew ( View Tweet)
