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EULAR 2021 – Day 2 Report

d Jack Cush, MD

During Day 2 there were great sessions devoted to RA, spondylarthritis, fatigue and more.  Here are some of my highlights from Day 2.

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New insights in RA-ILD therapeutics

d Aurelie Najm, MD, PhD

RA associated ILD (RA-ILD) is the most common extra-articular manifestation in RA. Its prevalence varies considerably, ranging from 5% to 30%, and is often underestimated since patients only become symptomatic or display abnormalities on chest X-Ray at a late stage of disease, leading to subsequent delay in diagnosis. In this context, several groups advocate for an earlier and more precise detection, using high resolution chest computed tomography (HRCT), which is the most sensitive for pre-clinical RA-ILD diagnosis.
But why would we want to diagnose early a manifestation that we cannot treat?

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JAKi has better retention than a bDMARD in RA! Single site study of RA pts prescribed advanced therapy in 320 Rxs in 215 pts JAKi lasted longer adjusting for age, sex, RA duration & line of therpy & 1st line Rx POS0205 #EULAR2021 @RheumNow https://t.co/4m2RXBkTDr

Janet Pope Janetbirdope ( View Tweet)
JAKi to #JAKi cycling is common in #rheumatoidarthritis Rx. Opal registry >53000 pts, 1/4 treated with JAKi (4000) & 44% new starts were Jaki. JAKi to JAKi cycling was >40%! POS0223 #EULAR2021 ⁦@RheumNow⁩ https://t.co/XV7wVJsE9c
Janet Pope Janetbirdope ( View Tweet)
Turning the Corner on CV Risk in Rheumatoid Arthritis by Richard Conway ( @RichardPAConway) #EULAR2021 https://t.co/S0ownscRKv https://t.co/PJODe0U6wr

Links:

Dr. John Cush RheumNow ( View Tweet)
Dr Hellgren on pregnancy outcomes in RA 📈disease activity assoc preterm birth and small gestational age. Low disease activity = no increased risk compared controls @RheumNow #EULAR2021 Abstr#OP0210 https://t.co/L26xWhIFv6
Richard Conway RichardPAConway ( View Tweet)
Pregnancy is a minefield for RA pts: dx activity➡️preg risk PNL➡️preg risk, but dx activity proxy? bring on Swedish/Danish linked data: 1739 RA preg matched 1:10 ⬆️pre-term/SGA risk with bDMARDs/PNL adj for dx activity: less bad, but still concern? OP0210 #EULAR2021 @RheumNow https://t.co/AlwFtmGcZH
David Liew drdavidliew ( View Tweet)
In the ESPOIR cohort of 813 RA followed for 10 years, polypharmacy associated w/ less DAS28 ESR Remission at 5 (45.0% in vs. 56.3% (p=0.03)) and 10 yrs (32.5% vs. 67.5% (p=0.06)) BUT no longer significant when adjusted for comorbidities! #EULAR2021 @Rheumnow #OP0098 https://t.co/pSrr1dzKFP
Aurelie Najm AurelieRheumo ( View Tweet)
Acute Coronary Syndrom incidence in > 24,000 RA from Nordic registers followed up to 5 yrs = 5.5/1000 pyrs. After 5yrs RTX show > risk of ACS compared to ETA. In patient with >= 2 previous DMARDs ABA, INF and RTX > risk of ACS compared to ETA. #EULAR2021 @Rheumnow #OP0114 https://t.co/MjW9LI2cjt
Aurelie Najm AurelieRheumo ( View Tweet)
Patients with RA > 70yo and risk of severe infection: which therapeutic strategy is the safest? #EULAR2021 @Rheumnow #OP0116

Aurelie Najm AurelieRheumo ( View Tweet)

Dr Yoshida analyze data from US registry 40,721 RA patients. High 2.11 [1.13, 3.96] and moderate 1.97 [1.13, 3.43] CDAI associated w/ > HR of major adverse CV events. HRs decrease during follow up. Tight and early disease control reduces CV burden! #EULAR2021 @Rheumnow #OP0101 https://t.co/A0ZYE4v8uf
Aurelie Najm AurelieRheumo ( View Tweet)
In 16,448 RA from ACR’s RISE registry: no difference in disease activity TNFi and non-TNFi at 12 months. Stratified analysis: ⬆️disease activity for TNFi vs. non TNFi in patients of Black and Asian ethnicity. To be confirmed in independent cohorts. #EULAR2021 @Rheumnow #OP0117 https://t.co/7bFnOKR9uz
Aurelie Najm AurelieRheumo ( View Tweet)
MTX or ETA which one withdraw first? @RADoctor SEAM-RA trial: PROs following withdrawal of MTX or ETN in RA patients with sustained SDAI remission receiving combination ETN+MTX. ETA > MTX for maintaining SDAI remission at W48 (49.5%-28.7% P=0.004) #EULAR2021 @Rheumnow #OP0118 https://t.co/MSOclXGMEK
Aurelie Najm AurelieRheumo ( View Tweet)
Can we predict pre-clinical RA-ILD? @Juge_P_A ESPOIR cohort. model w/ 4 variables: male gender, older age @ diag, mean DAS-28 over follow-up and MUC5B variant ▶️ preclinical ILD after 13 years of RA w/ AUC=0.82 CI 95% (0.72-0.91) (Sens 80%, Spe 56%) #POS0095 @Rheumnow #EULAR2021 https://t.co/bPyidNhNuO
Aurelie Najm AurelieRheumo ( View Tweet)
Can machine learning show JAKi effects for safety? Off target binding predicted in #tofacitinib 58, #baricitinib 41 but NO pathway for thrombosis or viral infection. Could have repurposing for + effects on lung vasculature & antifibrotic effects POS0091 #EULAR2021 @RheumNow

Janet Pope Janetbirdope ( View Tweet)

MACE events with #JAKi is as clear as mud! You voted >50% NOT Sure 1/3 only some Jakis vs MACE in #TNFi! Dunno #EULAR2021 @RheumNow @eular_org https://t.co/vWUgKSwAap
Janet Pope Janetbirdope ( View Tweet)
Poorer outcomes with #JAKi in pts who get #SARSCoV2 but ? related to line of therapy - worse off if 2nd line advanced Rx in RA vs 1st line? JAKi has short half life so it washes out? And..#baricitinib added to #remdesivir improves outcomes NEJM @RheumNow #EULAR2021 #OP0006 Dunno! https://t.co/583z6Mlw3y

Links:

Janet Pope Janetbirdope ( View Tweet)

News Feature: EULAR 2021 – Day 1 Report #EULAR2021 https://t.co/igpQYMkf9l https://t.co/qESsN3meJe

Links:

Dr. John Cush RheumNow ( View Tweet)
How common is RA ILD? @RheumNow #EULAR2021 @eular_org

Janet Pope Janetbirdope ( View Tweet)

RA ILD is NOT a needle in a haystack! Older age& makes & COPD is a risk MUC5B gene SNIP are risks NOT ACPA. 7-10% will have relevant RA ILD. Are you ready to identity & treat it? @RheumNow #EULAR2021 BI RA ILD symposium @eular_org https://t.co/4mS6Jejjqk
Janet Pope Janetbirdope ( View Tweet)

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