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Playing it Safe with RA? JAK vs. TNF Debate

Brian Jaros, MD

Reported safety signals, at odds with the efficacy of these medications, have left rheumatology clinicians in a difficult position when considering when during a patient’s treatment course and in which patients, specifically, JAKi should be used. Two abstracts from ACR convergence 2024 further contribute to our understanding of this potential risk profile.

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PsA.Hands_.jpg

Up-front Secukinumab in PsA?

Richard Conway, MBBChBAO, PhD

We now have an absolute plethora of agents available for use in psoriatic arthritis (PsA). In contrast we have an almost complete lack of understanding of how best to optimise use of these agents – what is the right agent at the right time for the right patient. A study presented this week has given us some further information on the topic.

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Gender

Gender Differences in SpA

Sheila Reyes, MD

One of the hot topics during the meeting was gender differences in SpA. Three abstracts presented addressed issues related to these differences particularly in the aspects of treatment response and disease activity.

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statin

ORAL Surveillance - Is Statin Use the Problem/Solution?

Eric Dein, MD

The findings from ORAL Surveillance Study have been a dominant conversation at recent ACR Convergence, with the seminal findings and subsequent analyses a target of debate. Subsequent post-hoc analyses, follow-up studies, and claims data analyses have been used to further interpret the data, though a clear answer on safety is not certain. A study presented on Sunday reported on a new post-hoc analysis that provides new insights.

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An early favorable response to TNFi initiation indicates better long-term success in RA. Assess early and adjust treatment accordingly. #ACR24 @RheumNow ABST#2674 https://t.co/YTThYiiLpZ

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Jiha Lee JihaRheum ( View Tweet)
Weinblatt et al. AMPLIFIED trial. No difference in response rates of RA to adalimumab or abatacept based on dual seropositivity/shared epitope status. Fits with my priors and refutes a previous pilot study. @RheumNow #ACR24 Abstr#2671 https://t.co/OUwnlsP6jU https://t.co/RBN6ivSKDr

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Richard Conway RichardPAConway ( View Tweet)
Conversation with @RheumKay on his #ACR24 biosimilar talk for @RheumNow https://t.co/LzAIGIG4wu https://t.co/CqSYLpJYAh

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Eric Dein ericdeinmd ( View Tweet)

JAK-pot! How fast do DMARDs work? Dr. Mike Putman interviews Dr. Kim Lauper about abstract 0501, How Fast Do JAK-inhibitors, TNF-inhibitors, Abatacept and IL-6 Inhibitors Act in Rheumatoid Arthritis? An International Collaboration of Registers of Rheumatoid Arthritis Patients… https://t.co/GO9EwyrVpV https://t.co/lELE5SJW5i
Dr. John Cush RheumNow ( View Tweet)
TNFis preventing cancer compared to placebo, and JAKi being neutral to placebo and maybe preventing haem cancers also. #ACR24 abstract 0989 was certainly provocative. I've shared my thoughts on @RheumNow https://t.co/yQFoUGifEN

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Richard Conway RichardPAConway ( View Tweet)

What is the effect of cs/bDMARDs on weight in #PsA? ⬇️Weight loss seen with: IL17i IL23i csDMARDs ⬆️Weight gain seen with: TNFi IL12/23i Important to consider #comorbidity & #BMI in management decisions in PsA Ab2639 #ACR24 @RheumNow

Mrinalini Dey DrMiniDey ( View Tweet)

A#2583 Apremilast for axial inflamm in PsA, assess by CANDEN MRI scoring MOSAIC P4 open label trial Reduction in inflammation seen in vertebral bodies & posteriolateral, not in facet joints No changes in SPARCC SIJ, spine - though low baseline SIJ inflammation @RheumNow #ACR24 https://t.co/3GKEGJbtdc

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Eric Dein ericdeinmd ( View Tweet)
A study investigating weight trends in Psoriatic Arthritis (PsA) and the impact of various medications. Analyzing 1754 patients, it explored multifactorial influences on weight changes Key findings: - Significant weight loss after starting IL17i, IL23i, and csDMARDs. - TNFi &… https://t.co/qOl2ojV9rL https://t.co/Eh2ZNLeKhn

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Antoni Chan MD (Prof) synovialjoints ( View Tweet)
#2286🔬Certolizumab Pegol (CZP) in High RF RA 📊Pooled analysis;N=1180 💥PBO: High RF=more radiographic progression v low RF (Wk24 6.5 v 2.8%,Wk52 17.6 v 10.4%) 💥CZP: min. progression regardless of RF (Wk24 0 v 1.1%;Wk52 5.3 v 3.1%) #ACR24 @RheumNow https://t.co/koel7SDsUb

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Caoilfhionn Connolly CaoilfhionnMD ( View Tweet)
Tesser et al. Implanted cervical vagus nerve stimulator for b/tsDMARD-IR RA. 242 patients. ACR20 week 12 35% vs 24%. Higher rates of DAS28-CRP LDA/remission. @RheumNow #ACR24 Abstr#L10 https://t.co/OXojHEMkKQ https://t.co/XSt97u7LrR

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Richard Conway RichardPAConway ( View Tweet)
@DianeLacaille Canadian biosimilar exp Biosimilar transition v originator controls x2 yrs Weighted model: no decr in ETN biosimilar discontinuation v originator. IFX shows slight decrease - NOT statistical signif Safety- no difference, slight incr rheum visits @RheumNow #ACR24 https://t.co/0GMfLAyzOo

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Eric Dein ericdeinmd ( View Tweet)
Biosimilar switching in practice Hyrich: UK experience Switching to biosimilar has no immediate benefit to patients but saves NHS money Allows for gain share that can be re-invested in pt care Transparency in switching in explaining to pts and offering resource @RheumNow #ACR24

Eric Dein ericdeinmd ( View Tweet)

Hyrich: ETN originator vs biosimilar initiation - DAS28 - no signif change at B/L, 6mo, 12 mo. Switch? Matched pts in ETN switch v cont originator - good b/l control on Rx -DAS28 maintained w switch 10% did go back to originator, felt less good tho similar DAS #ACR24 @RheumNow https://t.co/RHRit5CtUu

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Eric Dein ericdeinmd ( View Tweet)
A Bayesian Network Meta-analysis Phase II/III/IV, placebo-controlled, randomised clinical trials and long-term extension studies of JAKi and TNFi, in adults with RA, PsO, PsA, axial spondyloarthritis axSpA and IBD showed the following: - TNFi was associated with a significantly… https://t.co/FWHgemEAvG https://t.co/3D0nldwmwA

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Antoni Chan MD (Prof) synovialjoints ( View Tweet)
If a mother has had TNFi during pregnancy, can a baby have a live oral rotavirus vaccine (usually at 2mo)? This claims data suggests no increase in diarrhoea Adds to similarly reassuring 🇨🇦prospective cohort data https://t.co/2Tz9zRhPjz Vaccinate away! #ACR24 ABST0806 @RheumNow https://t.co/66OIAR8W6l

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David Liew drdavidliew ( View Tweet)
Instead of just JAKi, why don't we look at all our RA meds and MACE risk FAERS data & reporting odds ratios here: all the caveats of voluntary reporting, so don't put too much weight, but... prednisone. Don't forget pred is really not great for MACE! #ACR24 ABST1981 @RheumNow https://t.co/L9SlPZF2Jd

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David Liew drdavidliew ( View Tweet)
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