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GCA,woman

JAK inhibitors in GCA?

David Liew, FRACP

The SELECT-GCA study, looking at upadacitinib in GCA, anchored the ACR 2024 opening plenary for a reason - it is highly notable and badly needed.

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Are Emulation Trials a Fantasy?

Janet Pope, MD, MPH, FRCPC

Are emulation ‘trials’ helpful, despite the biases that occur with observational data, or do they truly mimic the results of randomized controlled trials (RCTs)?

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RIP displayed as rocks

RIP to Glucocorticoids in GPA

Richard Conway, MBBChBAO, PhD

For many years glucocorticoids were the mainstay of our treatment of granulomatosis with polyangiitis (GPA). The paradigm shifted with cyclophosphamide and then again with rituximab, and we used less steroids, but we still used lots. Avacopan teased the demise of steroids, but in the trial they, and now we, still use them. Glucocorticoids are our old trusty friend, our comfort blanket. But no more! Good riddance to the medication with the highest long-term adverse event burden that we use. Long-term glucocorticoids in GPA should now be a rarity. The reason for such exuberance is the TAPIR study presented by Dr. Peter Merkel at Saturday’s opening plenary session.

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How do we prevent SLE flares requiring steroids? Petri: Background medication! HCQ adherence is key -check WB levels to measure EULAR recs early addition of immunosuppress/biols “Taper quickly, withdraw slowly” Come down quick, then slowly off @RheumNow #ACR24 @jhrheumatology

Eric Dein ericdeinmd ( View Tweet)

How do you treat a flare of SLE with steroids? @RheumNow #ACR24

Eric Dein ericdeinmd ( View Tweet)

Petri: 5 mg prednisone or less is our standard for lupus control EULAR 23 recs - early addition of immunosuppressant and/or biologics instead to prevent steroids @RheumNow #ACR24 @jhrheumatology https://t.co/jhxEeboPu5

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Eric Dein ericdeinmd ( View Tweet)
Reset the bar for remission (off steroids)!! Session #17S19 3% higher risk of organ damage for each 1mg of pred Remission possible in rheum with lower dose GC regimen and faster taper #GCStewardship #ACR24 @RheumNow @BethIWallace

Jiha Lee JihaRheum ( View Tweet)

Petri on Steroids in SLE Steroid-related organ damage presents later - organ damage is higher in African-Americans Dose response for prednisone and CVD risk Each 1 mg prednisone = 3% increase risk in organ damage! #ACR24 @jhrheumatology @RheumNow https://t.co/00S1mxrXJp

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Eric Dein ericdeinmd ( View Tweet)
GILZ is a negative regulator of the GC receptor, a potential steroid sparer target. Dr. Miceli et al identified an E3 ligase of GILZ "E3-X" where deficiency leads to ⬆️ GILZ & ⬇️ inflammation. More studies needed but a promising steroid sparer option. @Rheumnow #ACR24 abs1646 https://t.co/GuVMkgOTXT

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sheila RHEUMarampa ( View Tweet)
Infertility in women with RA 2x higher Risk factors - age - disease activity - use of NSAIDs - use of pred >7.5mg/day With T2T aiming for remission, fertility improves and becomes similar to the general population #ACR24 @RheumNow ABST#1647 https://t.co/B2Tx4dju4Z

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Jiha Lee JihaRheum ( View Tweet)
17S19 session on steroid free future @LesleyJacksonMD @EBRheum @BritAdlerMD Is a (near) steroid free future for RA, ANCA, Lupus #ACR24 @RheumNow

Eric Dein ericdeinmd ( View Tweet)

It's always so dispiriting to see PMR patients rack up steroid side effects in front of your eyes. (the intense motivation to do better than pred for our PMR patients) #ACR24 @SattuiSEMD @RADoctor ABST0975 @RheumNow https://t.co/FTsvrTIt2F

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David Liew drdavidliew ( View Tweet)
New data to guide role of long-term, low dose GC in GPA Active GPA s/p tx -> randomized to d/c pred within 1 mo or stay on 5mg daily Fewer relapses on 5mg pred but w/qualifications: 👉 most flares = minor 👉 no difference in flares if RTX on board @RheumNow #ACR24 Abst 0774 https://t.co/Jvc40QWLqM

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Brian Jaros, MD Dr_Brian_MD ( View Tweet)
Hamroun et al. Meta-analysis of glucocorticoids in pregnancy and breast-feeding. Increase pre-term birth with GCs, adjusted OR 2.24. Dose-dependent effect. Minimal breastmilk transfer. @RheumNow #ACR24 Abstr#0810 https://t.co/H0o9ElsHmc https://t.co/uciFP6UOhF

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Richard Conway RichardPAConway ( View Tweet)
More steroid-sparing options for #IgG4RD! Abstract 0775: In pts w/ IgG4: - Inebilizumab (CD19-monoclonal ab) vs placebo associated with reduced risk of flare (HR 0.13; 95% CI 0.06, 0.28) AEs: infections, infusion reactions, lymphopenia #ACR24 @RheumNow https://t.co/Vr5hcd2E7E

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Akhil Sood MD AkhilSoodMD ( View Tweet)
This abstract reports that patients with ESRD 2/2 to GPA have a higher risk of vertebral fractures compared to individuals with ESRD without GPA. Even low dose steroids (pred 5mg) taken during the first year of HD conferred an increase risk or facture! #ACR24 @RheumNow https://t.co/4xM3XTCHSH

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Gabriela Martinez Zayas, MD MartinezZayasMd ( View Tweet)

TAPIR study of continuing vs stopping steroids in ANCA vasculitis in remission. Relapse at month 6 in 16% vs 4%. OR 4.22, but low rate in either group. If treated Rituximab, no difference! Merkel et al. @RheumNow #ACR24 Abstr#0774 #ACRbest https://t.co/pKa4U5L2fW https://t.co/MjzE14SeGi

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Richard Conway RichardPAConway ( View Tweet)
"If you want an argument, put two rheumatologists in a room and ask them about steroid tapers. Add a third and you'll have a fight" -P. Merkel at UPA plenary session #ACR24 @RheumNow

Mike Putman EBRheum ( View Tweet)

Results from SELECT-GCA ➡️UPA 15mg + 26W GC taper demonstrates superior efficacy & reduced GC use vs PBO + 52W GC taper ➡️No new safety signals Is UPA the new kid on the block in #GCA? Ab0770 #ACRBest #ACR24 @RheumNow https://t.co/pHzozYiid5

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Mrinalini Dey DrMiniDey ( View Tweet)
The TAPIR Trial on GPA shows higher (15.5%) relapse in the 0 mg prednisone arm vs. 4.2% in the 5 mg arm (OR 4.22), but does not impact PROs. Key finding: benefit of 5 mg/day seen only in non-rituximab regimens (20% vs. 2.6%, OR 9.50). Abstr#0774 Plenary 1 @RheumNow #ACR24… https://t.co/5DjW5Zwh0J https://t.co/UnsVPzJfs6

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Antoni Chan MD (Prof) synovialjoints ( View Tweet)
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