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ACR Best Abstracts - Day 3
The last day was jammed with important reports and research including the late breaking abstracts.
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The complexity of opioid use in spondyloarthritis
A few things we know about opioids: use is common; it’s not efficacious in the treatment of spondyloarthritis; and, there is an opioid epidemic and its users are stigmatized. Abstract 0402 is a retrospective study that looked at patients with psoriatic arthritis or ankylosing spondylitis in the FORWARD databank. It sheds new light and leaves us with some food for thought
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ACR22: Polymyalgia Rheumatica in the Spotlight
One of the enduring legacies of ACR 2022 for me will be the emphasis on polymyalgia rheumatica (PMR). Despite being highly inflammatory and relatively common, a remarkable paucity of trials have been run in this space. Read on for a quick PMR-roundup from the meeting!
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Abstr #2192 risk of serious infxn in newborns of mothers on TNFi by placental transfer
- % serious infection in TNFi in high vs low placental transfer (2.1% vs 1.6%)
- HR (high vs low) 0.98 (95% CI 0.36-2.61)
- No significant difference in risk of serious infxn
@RheumNow #ACR22 https://t.co/7Lfpf7PERu
Akhil Sood MD AkhilSoodMD ( View Tweet)
Flatman et al. Risk of infections in children with third trimester TNFi use, high vs low (CTZ, ETN) placental transfer. No difference but wide CIs, aHR 0.98 (0.36, 2.61) @RheumNow #ACR22 Abstr#2192 https://t.co/350UxX9bkL https://t.co/29uOtek8w7
Richard Conway RichardPAConway ( View Tweet)
Just so good to see PMR on the plenary stage at #ACR22, after #EULAR2022 too
SAPHYR study: sarilumab allows for
- a quicker steroid wean & less toxicity
- but also far more disease remission, quicker symptom resolution, better quality of life
Game-changing.
ABST1676 @RheumNow https://t.co/ZVqlMNoniu https://t.co/Fv3VRZrKGe
David Liew drdavidliew ( View Tweet)
Do you think you need a #steroid sparing Rx in #polymyalgia #rheumatica? +data in #sarilumab w 14 wk ped taper. No diverticulitis, ?Stacking comparator grp to flare as past steroid tapering caused a flare. But that is an unmet need after long pred Rx Abst#1543 #ACR22 @RheumNow https://t.co/Q1bhYs7LEz
Janet Pope Janetbirdope ( View Tweet)
Intersting discussion post Plenary this AM
- Agree w/RS that we should taper steroid
- Is there a disease modifying benefit? I think not
- When should this be used? Disagree w/RS, I would not use unless relapsing/refractory and requiring >10mg pred
#ACR22 @RheumNow https://t.co/ylGXk2sca7
Mike Putman EBRheum ( View Tweet)
Are your SpA pts planning on conceiving? Be careful with NSAID use
French study found age and NSAID use associated with longer time-to-conception.
Factors not associated: smoking, BASDAI score, DMARD use
#ACRBest Abs#1673 @RheumNow #ACR22 https://t.co/D63XTY7IB8
Robert B Chao, MD doctorRBC ( View Tweet)
Ab1674 #ACR22 HCQ in pregnancy is SAFE and Standard of Care!
In Utero Exposure to HCQ does NOT ass w/ ocular toxicity: OCTs 5 yrs after birth 👀
PATCH study of HCQ to reduce CHB in pregnancy
18% CHB (historical) -> 7% treated risk
OCT: retinal thickness nml at 5 yrs
@RheumNow
Eric Dein ericdeinmd ( View Tweet)
Are TNFi or IL-6Ri safe in rheumatic irAEs from ICI Rx?
Multiple big US centers retrospective:
TNFi, IL-6Ri vs MTX
p>0.05, but may be approx 2x risk of cancer progression
Has made me more cautious about TNFi, IL-6Ri - use MTX when you can
Lovely work! ABST1669 #ACR22 @RheumNow https://t.co/cfAT1pQZ7I
David Liew drdavidliew ( View Tweet)
Maya Buch on major adverse CV events in tofa vs TNFi. Post-hoc analysis of phase 3b/4 data looking at cohort enriched for CV events.
@RheumNow #ACR22 #LateBreaking
Julian Segan JulianSegan ( View Tweet)
L06 #ACR22 ORAL Surveillance Updates!
Composite of all ischemic CV events and HF did NOT show difference b/w TOFA vs TNFi
But, MACE numerically higher with Tofa w/ h/o ASCVD
Highest CV risk in TOFA 10 mg BID, 2/2 VTE risk
Most important risk is pt's individual risks
@RheumNow https://t.co/jPPX7f5GRE
Eric Dein ericdeinmd ( View Tweet)
Across extended MACE endpoints risk was numerically higher with tofacitinib vs TNFi in pts with a history of artherosclerotic CV disease (ASCVD). CV risk (MACE-8 with HF +VTE) was higher in the Tofa 10mg bd vs TNFi. Buch M #L06 https://t.co/lFXl2ywbZe #ACR22 @RheumNow
Dr. Antoni Chan synovialjoints ( View Tweet)
Nestor et al. HCQ <5mg/kg day assoc increased hospitalisation for SLE flare. aOR 4.41 (95% CI 1.50-12.98) @RheumNow #ACR22 Abstr#1654 https://t.co/I4bTu2DWaR https://t.co/jpOwHUTenk
Richard Conway RichardPAConway ( View Tweet)
Are we giving enough HCQ?🤔
Findings from the study of Dr J Nestor show that ⬇️dose HCQ (</= 5mkd or <400mg/day) is associated w/ ⬆️hospitalizations for #lupus (adj. OR 4.41; 3.48)
#ACR22 @RheumNow ABST#1654 @rheumarhyme #ACRBest https://t.co/XCoZgbdOim
sheila RHEUMarampa ( View Tweet)
Ozen et al. Safety Opioids vs NSAIDs in RA. Similar risks except 2-fold increase in VTE with opioids. @RheumNow #ACR22 Abstr#1646 https://t.co/kWBf8t4TFh https://t.co/dxKoilOhFX
Richard Conway RichardPAConway ( View Tweet)
Castrejon et al. Cancer risk with b/tsDMARD in BIOBADASER. Again not looking great for abatacept, Rate ratio vs TNFi 2.2 (1.4-3.2). Age-adjusted HR 1.6 (1.0-2.6) @RheumNow #ACR22 Abstr#1752 https://t.co/PvBq2O9qPv https://t.co/XBfistBMhW
Richard Conway RichardPAConway ( View Tweet)
Low dose #glucocorticoids in rheumatic diseases can lower bone mass and increase # even 2.5 mg #prednisone. The change in #BMD was more predictive of fracture not absolute BMD. L01 #ACR22 #ACRBest @RheumNow https://t.co/MbTk0L4DoK
Janet Pope Janetbirdope ( View Tweet)
NSAIDs and CV risk in Inflammatory Arthritis
Dr. Richard Conway discusses abstract 1207, being presented #ACR22 meeting.
https://t.co/CjU2YbA3tk https://t.co/bHE4xw2IRF
Links:
Dr. John Cush RheumNow ( View Tweet)
