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So who with inflamm arthralgias might benefit from abatacept, in terms of delaying RA onset?
ALTO study (APIPPRA continuation)
1y abatacept then follow
If autoAb x5 (RF, ACPA IgG, IgA, anti-CarP, AAPA): sustained delay of RA
If not: benefit only on Rx
#ACR25 ABST1678 @RheumNow https://t.co/3Pc5ZLzVf6
Links:
David Liew drdavidliew ( View Tweet)
Early TNFi treatment leads to
-Less D2T at 5 yrs
-More sustained remission at 10yrs
-Less bDMARD escalation at 5yrs
-More DMARD free remission at 5yrs and 10 yrs
-20% reduction annual healths costs
-11 mo delay in ttmt escalation
Safety data were not presented
#ACR25 https://t.co/jPMGUGPtqP
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Aurelie Najm AurelieRheumo ( View Tweet)
In case you missed it in @ACR_Journals: HCQ for 1y does not prevent RA development in people with CCP3 >2x ULN, either:
- during 1y of treatment
- in 2y follow-up
https://t.co/gtzNiSmutb
but StopRA will give us plenty of insights - data is never wasted
#ACR25 ABST1674 @RheumNow https://t.co/DDZib5VGtX
Links:
David Liew drdavidliew ( View Tweet)
In the IMPACT trial (Abs 0855), certolizumab met its primary endpoint: <20% had an adverse pregnancy outcome (APO) among females w/ APS & prior APO.
✅ 94% live births, all survived to discharge
📈 Median GA: 37 wks (no APO) vs 31 wks (APO)
@RheumNow #ACR25
Akhil Sood MD, MS AkhilSoodMD ( View Tweet)
Did we need a 2nd Interception RCT of HCQ in Pre-RA?
Unsure but in any case, it does not work either
STOPRA CCP3+>=2 ind 71 HCQ and 74 PBO
36 months RA conversion
Dr Deane's take: "probably wrong drug rather than wrong timing"
#ACR25 @RheumNow #ABSTRACT1674 https://t.co/jysdo8iz7v
Aurelie Najm AurelieRheumo ( View Tweet)
Like PEXIVAS steroid taper, this is something we need an online resource to check each time. Its complicated, but feels "right". @RheumNow #ACR25 https://t.co/QAgSQB9XMQ
Richard Conway RichardPAConway ( View Tweet)
In a cohort of 269,304 IBD patients, NSAID use showed a small increase in IBD-related hospitalisation (HR 1.08), meeting non-inferiority threshold (HR <1.2). No risk in UC (HR 0.96); modest risk in Crohn’s (HR 1.16). Relooks at the current paradigm of blanket NSAID avoidance in https://t.co/O8MWg1BP50
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
56 pts w/tracheobronchial stenosis in GPA, highly frustrating disease manifestation
Not surprising to see severe dx & prior intralesional tx assoc with incidence (ie necessity) of tracheal dilation
Leflunomide protective? Have others seen this?
#ACR @RheumNow Abstr#1596 https://t.co/djJXnAkxnv
Mike Putman EBRheum ( View Tweet)
In a prespecified exploratory analysis of REGENCY trial data by DrRovin et al,
Bet. wks 24 and 76:
Obinutuzumab ⬇️ LN flares vs. PBO (HR 0.44; p=0.0074)
Pts on Obi had less unfavorable kidney outcomes vs. PBO (HR 0.37; p=0.0039)
Addtl tx option for LN
#ACR25 @RheumNow Abs1521 https://t.co/N5K9Nzh71E
sheila RHEUMarampa ( View Tweet)
Simko et al. 6-monthly vs 3-monthly MTX lab monitoring. 3821 patients. Appears to be no difference. Potential for significant cost-savings and reduced burden to patients. @RheumNow #ACR25 Abstr#1370 #ACRbest https://t.co/G3tNQq8qXT
Richard Conway RichardPAConway ( View Tweet)
Infection data from SELECT-GCA:
Glucocorticoids seem to drive overall infectious risk
UPA use associated with higher zoster - vaccinate!!
@RheumNow #ACR25 Abst# 0895 https://t.co/ueVbFPxG0Q
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
Post Hoc analysis from SELECT-GCA
Increased rate of herpes zoster for 26wk steroid-UPA 15mg (7.3% vs 4.2% 52wk steroid-plbo) but lower rate of SERIOUS infections (7.9% vs 12.7% 52wk steroid-plbo)
Zoster risk is real; steroids are the bigger problem
@Rheumnow #ACR25 Abstr#0895 https://t.co/IKzO2J4hLH
Links:
Mike Putman EBRheum ( View Tweet)
Concerns using dupilumab in EGPA due to secondary eosinophilia
What about when combined with IL-5 therapy?
16 pt on dupi + IL5 agent
- if dupi alone caused eosinophilia -> quelled by IL-5
- no eosinophilia when dupi added to IL-5
- effective but slow
@RheumNow #ACR25 Abst 1605
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
Liraglutide had decreased synovial inflammation and fibrosis in mouse models, however dexamethasone didnt have changes in fibrosis scores
Abst#1734 #ACR25 @RheumNow https://t.co/O4JYGtDD5N
Bella Mehta bella_mehta ( View Tweet)
Analysis from FVSG identified 36pts with anti-rituximab antibodies
In AAV, lookout for this in pts who are MPO+ & w/higher CD19 at 6 mos. Worse relapse free survival in both AAV & CRYO!
@TerrierBen can you share the prevalence of these abs?
#ACR25 @RheumNow #ACRBest abstr#1604 https://t.co/Nyx6JxbvUk
Links:
Mike Putman EBRheum ( View Tweet)
Ultra-low dose (ULD) RTX in AAV maintenance
200mg q6 mo vs. 500mg q6 mo interim analysis
No major difference in infection risk or hypogammaglobulinemia thus far but both doses appeared similarly efficacious
#ACR25 @rheumnow Abst 1609 https://t.co/ZGYNVGY3dr
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
NEREA registry study on mortality in progressive pulmonary fibrosis in SARD-ILD. 158 patients. Median survival 7.8 years. DMARD use associated improved mortality. @RheumNow #ACR25 Abstr#1024 https://t.co/rK1caGi2r4
Richard Conway RichardPAConway ( View Tweet)
In this MTX+PNL vs TCZ+PNL in GCA study, we saw 5 pts on MTX+PNL get PJP, very surprising.
@EBRheum asked what I knew/hoped he’d ask: why did this happen?
PJP is v rare in GCA
(https://t.co/oPN0dpvG8Q) & with MTX in other diseases.
Worth interrogation!
#ACR25 ABST0891 @RheumNow https://t.co/rsbScryIFR
Links:
David Liew drdavidliew ( View Tweet)
Is MTX worth anything in GCA?
METOGiA: MTX 52w vs TCZ 52w for GCA
MTX didn’t achieve non-inferiority to TCZ, but:
- clearly it does something
- continue both >1y: after MTX/TCZ therapy ended, they ended up with same relapse-free survival, cumulative GC
#ACR25 ABST0891 @RheumNow https://t.co/WvvkHKIXuQ
Links:
David Liew drdavidliew ( View Tweet)
Open-label MTX vs. Toci in GCA in METOGiA
Wk 78:
37% w/o relapse in MTX arm
46% w/o relapse in Toci arm
MTX was NOT non-inferior to Toci
Toci superior in 2ndary endpoints
Cumulative doses GC not significantly different
#ACR25 #ACRBest @RheumNow Abst 0891 https://t.co/lCaP4EdJ9C
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
