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JAK inhibitors in GCA?
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?
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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ACR 2024 - Day 1 Report
ACR Convergence 2024 opened today with a full slate of presentations, posters and specialty meetings. The meeting began with a flip: the plenary sessions started at 9AM and the poster session began at 1030 AM. Below are some of the highlights from day one in Washington, DC.
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Chinoy et al. Baricitinib in IIM. Delayed-start clinical trial. 15 patients. 14/15 improved at 24 weeks (the other withdrew). 50% vs 100% at week 12 (delayed start group initiation). Stats confuse me a bit here but promising. @RheumNow #ACR24 Abstr#1731 https://t.co/orewsxbPpL https://t.co/5AyRpYJdec
Links:
Richard Conway RichardPAConway ( View Tweet)
#Upadacitinib rises ‘ Up’ in all subgroups of #GCA Subset of overall #RCT of #rinvoq w more reduction of #steroids vs placebo+ slower #prednisone taper Consistent results best in UPA 15 mg >UPA 7.5mg/d > #placebo #ACR24 #ACRBest @RheumNow @ACRheum abst#1695 https://t.co/dA7RkNmWFd
Janet Pope Janetbirdope ( View Tweet)
Alright help me out here; this is pretty implausible, right?
Why would be pts be 11% more adherent to UPA? What's the bio-plausibility here? UPA 10% better than other JAKs?
Could do a network meta analysis; betting this doens't replicate
#ACR24 @RheumNow Abstr#1362 https://t.co/vpPq3vu9Wf
Links:
Mike Putman EBRheum ( View Tweet)
No Increase in Cardiovascular Events with JAK Inhibitors in IBD Patients
UMKC researchers have compared the use of JAK inhibitors versus tumor necrosis factor (TNF) blockers in inflammatory bowel disease (IBD) patients, but failed to see an increase in major adverse… https://t.co/IOzckJIfYf https://t.co/8S6FnffVLG
Dr. John Cush RheumNow ( View Tweet)
TYK2/JAK1 in Dermato? Interesting pre-clinical study of brepocitinib... but we really just need clinical data
Glad to see this is headed straight to a Phase 3! Hoping they allow IVIG: has been a problem with many/most/all? recent dermato studies
#ACR24 @RheumNow Abstr#0882 https://t.co/KS8fTMBpPR
Mike Putman EBRheum ( View Tweet)
In this large 🇦🇺 RA cohort, median time on treatment for upadacitinib was lot higher than other JAKi
(28mo vs 17mo)
Why?
Patient selection, or a real difference between JAKi?
Would really like more comparative effectiveness data between JAKi
#ACR24 OPAL group ABST1370 @RheumNow https://t.co/OU2ayzqIc8
David Liew drdavidliew ( View Tweet)
Spicy network SRMA, 123pts w/JAK-TNF-PLBO
TNF >> JAK w/respect to malignancy (expected) & better than PLBO (spicy!)
JAK > PLBO for heme cancers (makes sense); no significant (but slight trend) toward PLBO > JAK for all cancer
The debate continues
#ACR24 @RheumNow Abstr#0989 https://t.co/tBnb02gyzF
Mike Putman EBRheum ( View Tweet)
Which RA patients are at increased risk of JAKi adverse events? Does disease activity matter?
in the upadacitinib ph3 trials, high disease activity pts had more:
serious infections
HZ
MACE
VTE
Active RA is a massive contributor to many AEs in JAKi pts
#ACR24 ABST1393 @RheumNow https://t.co/DlFf9Sfbja
David Liew drdavidliew ( View Tweet)
Gottlieb et al. TYK2i Zasocitinib in PsA. 12 week phase 2 RCT. Skin responses and MDA all favour zasocitinib but maybe not fantastic? PASI75 46%, PASI90 37%, PASI100 26%. MDA in photo. @RheumNow #ACR24 Abstr#1477 https://t.co/iX5iriESV2 https://t.co/RkEmcAZ80x
Links:
Richard Conway RichardPAConway ( View Tweet)
Slick poster, but must be careful w/real world data. Big risk of confounding/channeling bias
Pts with MACE risk (not always well-characterized by ICD codes) also less likely to receive JAK & therefore less liekly to have subsequent MACE
#ACR24 @RheumNow Abstr#1394 https://t.co/lilU0byJ1s
Mike Putman EBRheum ( View Tweet)
Getting more data on using deucravacitinib for PsO/PsA manifestations
Impressive effect on scalp psoriasis (which often means a lot to patients)
Given how safe it is, it's increasingly tempting to use more of it in mild-mod PsA
#ACR24 PSORIATYK SCALP trial ABST1137 @RheumNow https://t.co/vxS3RSlIN0
David Liew drdavidliew ( View Tweet)
Serrano-Combarro et al. Case series of upadacitinib in RA-ILD. 18 patients. Report stable/improved dyspnoea and HRCT over 12 months. PFTs shown, relatively stable @RheumNow #ACR24 Abstr#1372 https://t.co/yncy0lPq60 https://t.co/mrDMtEDwUt
Links:
Richard Conway RichardPAConway ( View Tweet)
#1477 🔬Zasocitinib (TYK-2i) shows promise in phase IIb RCT
➡️n=290, randomised to PBO, 5/15/30mg gps
💥30mg group
📉 Rapid skin improvement @ Wk 2
➡️Wk 12 PASI:~2X placebo (-2.5;p=0.004)
🛟Well tolerated
⬆️MDA (28 v. 12.5% p<0.05) promise for other PsA domains
#ACR @RheumNow https://t.co/5GusMlVkQ4
Caoilfhionn Connolly CaoilfhionnMD ( View Tweet)
Exciting early data for new highly selective TYK2i zasocitinib
Improved PASI skin scores (though not as much as IL23i...)
Funky skin-related adverse events at higher doses, not sure what to make of that?
#ACR24 @rheumnow Abstr#1477 https://t.co/CtOFsoHdBh
Links:
Mike Putman EBRheum ( View Tweet)
Race of b/tsDMARDs in RA, the “JAK-pot” study.
JAKi and TNFi with more rapid early improvement in CDIA, HAQ, and pain compared to ABA or IL-6 inhibitors…..although effects blunted after adjusting for patient and RA characteristics
#ACR24 @RheumNow ABST#0501 https://t.co/8M4wX3LAbW
Jiha Lee JihaRheum ( View Tweet)
🤵♂️Results from BACHELOR
➡️34 PMR pts
➡️18 BARI, 16 PBO
➡️Primary endpoint: CRP PMR-AS≤10 w/o oral GC rescue from W0 to 12
78% BARI pts reached primary endpoint vs 13% PBO
No new safety signals
BARI 4mg 12W, then 2mg 12W➡️36W low disease activity in PMR
Ab0858 #ACR24 @RheumNow
Mrinalini Dey DrMiniDey ( View Tweet)
JAKs in PMR? "BACHELOR" study randomized 34pts to BARI vs PLBO
Despite small sample, significant benefit at 12 wks (CRP PMR-AS < 10) for bari (78%) vs. PLBO (13%)
Useful, but not for getting regulatory approval. Should have gone straight to phase 3!
#ACR24 @RheumNow Abstr#0858 https://t.co/mmMs6c3AYC
Links:
Mike Putman EBRheum ( View Tweet)
