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The Influence of Obesity on Choice of Biologic Agent in Rheumatoid Arthritis
In rheumatoid arthritis we have a wide range of options available to us when we progress to a biologic treatment option. We have little to differentiate between these agents based on the clinical trials.
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FDA Update: 3 trials showing Efficacy of Tocilizumab in COVID 19:
1. RECOVERY - lower mortality
2. EMPACTA - Less progression to mech vent or death
3. REMDACTA & COVACTA - did not meet primary endpoints (but not contradictory) FDA Metanalysis of all 4 trials #ACR21 EUA 6/21 https://t.co/9yHu87KGej
Dr. John Cush RheumNow ( View Tweet)
TCZ in GCA: one disadvantage is that you can't use CRP+/- ESR for flares
Mavrilimumab in GCA:
- CRP/ESR consistently go up with symptomatic flares
- CRP/ESR up less (cf. placebo), in the absence of Sx flares
More signal, less noise.
phase 2 post-hoc #ACR21 ABST1401 @RheumNow https://t.co/c0lMJMcQv0
David Liew drdavidliew ( View Tweet)
NORD-STAR Trial: outcomes in tx-naïve, early RA pts after 48w of csDMARDs+GC vs bDMARD (ABAtacept, CerToliZumab, or ToCiluZumab)+MTX
➡️ Superior CDAI remission rates w/ ABA+MTX & CZP+MTX but not TCZ+MTX vs csDMARD+GC
➡️Imaging progression low in all
Abst#0825 #ACR21 @RheumNow https://t.co/QaFIF4WNEG
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
#ACR21 Abs#0834: CorEvitas Registry TNFi vs IL-6 in RA
⭐️IL6 pts older, longer h/o RA, higher CDAI, more prior Rx
▶️ No difference in outcomes bw IL6 and TNFi (monotherapy or combo w MTX).
▶️1/3 of pts achieved LDA
Limits: real-world, unblinded
https://t.co/AJtzeMuj1T @Rheumnow
Links:
Eric Dein ericdeinmd ( View Tweet)
ADACTA & MONARCH both showed IL6i monoRx > TNFi monoRx for RA in DBRCTs.
What about in real-world data?
Looking at CorEvitas, less so
LDA: aOR 0.99
MCID in CDAI: 1.06
Even without MTX, both great drug classes for RA
Equally so?
#ACR21 ABST0834 @RheumNow https://t.co/6wvzVrXTW6 https://t.co/fYEktJhZuV
David Liew drdavidliew ( View Tweet)
It's all happening for biologic therapies in PMR!
phase 2/3 double-blind RCT:
- new PMR
- n=36
- 11w PNL taper (until relapse - clinical not lab)
- weekly sc TCZ for 16w vs placebo
big benefit persists post-TCZ cessation
real steroid sparing
PMR-SPARE #ACR21 ABST0507 @RheumNow https://t.co/w8tgOPAtyJ
David Liew drdavidliew ( View Tweet)
In GCA, why might you target GM-CSF over IL-6?
Entirely plausible TCZ might be leaving some Th1 stones unturned, esp:
vascular remodelling
downreg pathways
Transcriptomics from toci/mavri-treated TAB show it's plausible beyond just theory...
Cid group #ACR21 ABST0506 @RheumNow https://t.co/YephlzHOdj
David Liew drdavidliew ( View Tweet)
Gender differences in AS pts?
IL-23R, IL-12R, IL-6R, JAK, STAT and TYK2 ⬇️regulated in men
Small study of 20 pts, but could it guide targeted therapy based on gender?🤔
Abs#0050
https://t.co/OQHQCCzfuC
#ACR21
@RheumNow
Links:
Robert B Chao, MD doctorRBC ( View Tweet)
#ACR21 Abst#0269
⭐️TCZ: ⬆️cholesterol, LDL, TG. ⬇️ hsCRP compared to TNFi. No ⬆️ risk of Reynold risk score (RRS)
Take-away: good data on TCZ effect on lipids, but I wouldn't use RRS to calculate CVD risk on med that ⬇️ CRP @Rheumnow https://t.co/zMltktfHkS https://t.co/bwKXiGIi8a
Links:
Eric Dein ericdeinmd ( View Tweet)
