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Choices in GCA
There are a number of diseases where new biologic and targeted synthetic therapeutic options are coming online, and the temptation will be to consider them all equally. GCA is one of those diseases.
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Summary of #EULAR2024 #ClinicalPearls
JAKi have expanding disease data
✅ #GCA w #UPA
✅ Awaiting data in #SLE w #UPA & #Deucravacitinib
✅Use in #JIA
✅No new safety signals
@rheumnow
@eular_org
Janet Pope Janetbirdope ( View Tweet)
Once in remission with
#rituximab in #GPA
How long to resize
500 mg q6 mo for
4 years?
?longer
?less
#EULAR2024 @eular_org @RheumNow https://t.co/G4kU3v81je
Janet Pope Janetbirdope ( View Tweet)
#EULARBEST
RCT of #upadacitinib in #GCA
It works to steroid spare
15 mg > 7.5 mg in outcomes
Both >>placebo
Ethically PBO had slower #prednisone taper
Similar to #TCZ data
What to choose in GCA
IL6i
IL17i
JAKi
@eular_org @RheumNow LBA0001 https://t.co/gy0TEiHxjo
Janet Pope Janetbirdope ( View Tweet)
PMR patients get too much steroid.
Data across 27 million people in England, n=39,438 with PMR.
The blue are getting more pred than guidelines.
Like everything in rheum: we need to be giving less pred, not more. Lumping PMR in with GCA won’t help.
#EULAR2024 POS0411 @RheumNow https://t.co/bsi3lrAafm
David Liew drdavidliew ( View Tweet)
#EULAR2024 POS0234 The effect of prophylactic Septrin in ANCA #vasculitis pts treated with RTX/CyC need further characterisation. Multicentre study in Korea showed protective effect on Serious Infection btw those treated vs not. Effect was seen in the first 3mths only @RheumNow https://t.co/dCzD21589S
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
EULAR Abstract Archive
OP0283 (2024)
LONG-TERM EFFICACY TOCILIZUMAB AFTER ULTRA-SHORT GC TO TREAT GCA: 3 Yr FOLLOW-UP OF THE GUSTO TRIAL
3 day GC pulse immediate 12 mths Toci 85% drug free remission at 4 yrs! https://t.co/XWnzuVMlbn @RheumNow #EULAR2024
Links:
Peter Nash drpnash ( View Tweet)
#EULAR2024 LBA0001 New Steroid-sparring therapy for #GCA. Phase 3 RCT showed Upadacitinib 15mg met primary endpoint (sustained clin remission frm Wks 12-52 & adherence to 26Wk GC taper) vs PBO [46% vs 29%] & multiple secondary endpoints. No new safety signals @RheumNow https://t.co/edfSZkMuy2
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
LBA0001 UPA in GCA- Phase 2 RCT
15mg UPA with 26w steroid taper showed
⬆️ efficacy
⬇️ steroid use
vs placebo with 52w steroid taper
Potential new target on the horizon for #GCA??
@RheumNow #EULAR2024
Mrinalini Dey DrMiniDey ( View Tweet)
Enjoyed the #PolymyalgiaRheumatica session at #EULAR2024? Make sure to download our first atlas imaging article, where @drceowen, @drdavidliew et al. characterise PMR using whole-body PET/CT 👀
➡️ https://t.co/tbu0DgAFIS https://t.co/W06YbYyjRx
Links:
Rheumatology & Rheumatology Advances in Practice RheumJnl ( View Tweet)
Maintenance of remission in GPA/MPA.
RTX for 48 months sounds good to me.
#EULAR2024 https://t.co/5YGwOHhCuX
Nouf Al hemmadi NoufAhmedAlham2 ( View Tweet)
#wasup in #GCA?
#upadacitinib +RCT in #temporal #arteritis LBA0001
Residual #inflammation in 1/3 of pts at 6 mo #Rx w #TCZ on repeat TA Bx
OP0621
#PMR cases
#Leflunomide beats #MTX for
#pred sparing
⬇️relapses
But MTX dose was low
POS0280
#EULAR2024 @RheumNow @eular_org
Janet Pope Janetbirdope ( View Tweet)
#EULAR2024 POS1420 A cohort study with 1/3 each with GCA, PMR and GCA+PMR found that at 6mth, 16% of patients had new diabetes/diabetes worsened. Worse in GCA+PMR group with the greatest GC accumulation. Call for better GC-sparing strategy @RheumNow https://t.co/ex7u83bVfj
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
#EULAR2024 POS0742 A single cohort study showed for non-criteria #APS, cardiac manifestation (valvular dysfunction & regurgitation) was more common in Triple Ab+ vs Non-Triple Ab. We should monitor and consider an echocardiogram for this group of patient @RheumNow https://t.co/VxFUSpjaG1
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
If your GCA flares, do you get the same features as you did at diagnosis?
20% of the time it can be new, so keep on doing the checklist!
(also, visual flares uncommon - the power of pred)
#EULAR2024 POS0110 @MayoClinic @MdWarrington @RheumNow https://t.co/hkF8vJT6HI
Links:
David Liew drdavidliew ( View Tweet)
Just a reminder - large vessel involvement is very common in GCA, and lines up with aortic dilatation. And if you don’t look, you won’t find…
#EULAR2024 POS0932 @RheumNow https://t.co/2uZTu0B18Z
David Liew drdavidliew ( View Tweet)
Prof Hellmich takes us through “What is new?” In ANCA #vasculitis
A tour de force in management strategies and, continuing a theme of #EULAR2024, ends with a study suggesting the potential of #CAR-T!
@RheumNow https://t.co/K3dDqZhUvD
Mrinalini Dey DrMiniDey ( View Tweet)
Predicting who will develop
▶️#GCA
In #Swedish study with
#PMR
⬆️ in HIGH ESR/CRP
⬆️female
⬇️ if hip pain/stiffness
Not all sig 1 mo after #prednisone started
Only 9% with #polymyalgia #rheumatica developed #GCA
? ⬇️GCA % in PMR over time
#POS0411 @eular_org @RheumNow https://t.co/UMhxlYd0Pv
Janet Pope Janetbirdope ( View Tweet)
Leflunomide for #PMR?
✅ #Leflunomide FAR more effective than #MTX in #polymyalgia #rheumatica
V fast withdrawal of #prednisone
#LEF ~4 to 5 months
#MTX 30 mos!
⬇️flares w LEF
😮
#EULAR2024 @RheumNow @eular_org
@SebaUltraTrail https://t.co/2hk0yMH6gY
Links:
Janet Pope Janetbirdope ( View Tweet)
Does TCZ switch off GCA histopathologically?
GCA pts still on TCZ (median 2.4y duration) had repeat temporal artery biopsy (contralat)
Despite serological remission on TCZ, a heap had active histopath findings & PET still active. Scary
#EULAR2024 OP0233 Reggio Emilia @RheumNow https://t.co/TKBUP5p4R0
Links:
David Liew drdavidliew ( View Tweet)
