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Monitoring Infliximab Drug Levels Improves Efficacy
Should we start considering therapeutic drug monitoring when prescribing TNFi for treatment of our rheumatologic conditions?
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The Need for Comparative Treatment Trials in Psoriatic Arthritis
Psoriatic arthritis is currently experiencing a burgeoning selection of treatment options. While this is a very welcome development in a disease which has had less treatment options compared to RA, it leaves us with a difficult conundrum: which agent to choose for an individual patient.
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ACR21 Best Abstracts We Saw - Day 3 (Monday)
The third day of ACR 2021 took a big leap in online content. Here is a compilation (with links) of presentations were the “ACRBest” as seen by our RheumNow faculty.
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#ACR21 Ab#1941: ORAL Surveillance VTE risk
▶️Tofa 10 BID risk > 5 BID > TNFi for VTE, DVT, PE
▶️Age, male, obesity, HTN, h/o VTE, oral contraception/HRT, steroids, antidepressants were risk factors
@RheumNow
https://t.co/JOKNyYVZfX https://t.co/mTkgkwPIT6
Links:
Eric Dein ericdeinmd ( View Tweet)
#ACR21 Ab#1939: Tofa CV Outcome (STAR-RA)
▶️Pooled data does not show ⬆️ risk of CVD
▶️Trend in pts w prior CVD -HR 1.27 (0.95-1.7), cannot r/o CVD risk in pts w risk factors
Less clear than oral surveillance data, but concerns in those w risks
https://t.co/JOKNyYVZfX @Rheumnow https://t.co/GGYJfxcqhc
Links:
Eric Dein ericdeinmd ( View Tweet)
ORAL Surveillance malignancy risk @RADoctor . Numerically higher at both doses tofacitinib compared to TNFi . Abstr#1940 #ACR21 @RheumNow https://t.co/uc2k5EaiRq
Richard Conway RichardPAConway ( View Tweet)
STAR-RA, CV risk
large insurance datax3
tofa vs TNFi
all comers: HR 1.01 (0.83-1.23)
one CV RF + any MTX: HR 1.24 (0.90-1.69)
prev CVD: HR 1.27 (0.95-1.70)
not sig
but surely okay to say baseline CV risk + tofa makes me a little nervous?
@SeoyoungCKim #ACR21 ABST1939 @RheumNow https://t.co/LmmL5zgv9u
David Liew drdavidliew ( View Tweet)
Another study linking long term GC and CV risk in RA!
Medicare data >65yo 130000+ pts
1-year incidence CV ⬆️ as follows:
📍Dose ≤5mg 1.4%
📍Dose 5-10mg 1.7%
📍Dose >10mg 1.9%
Not replicated in younger pts (Optum data)
#ACR21 #Abst1915 @RheumNow https://t.co/DLXdfvfiBW
Aurelie Najm AurelieRheumo ( View Tweet)
#ACR21 Abs#1915
👉🏼Chronic steroid use in older adults on stable DMARD therapy
assoc w/ ⬆️CV risk
👉🏼Risk even present among older adults receiving low dose ≤5mg/day
👉🏼Larger studies needed in younger healthier adults
@RheumNow https://t.co/Lsj5YBz7IG
Mrinalini Dey DrMiniDey ( View Tweet)
Long-term low dose glucocorticoid use associated ⬆️cardiovascular risk. Clear effect in Medicare population (older), not evident in Optum (younger). Dose dependent. Abstr#1915 #ACR21 @RheumNow https://t.co/oFet3Hhsfo
Richard Conway RichardPAConway ( View Tweet)
Important late breaker @TerrierBen, DBRCT of RTX vs GC (FFS=0) or CYC (FFS>0) for EGPA
RTX not superior to CYC (64% RTX vs 60% CYC BVAS remission d180, p = 0.745); similar in subgroups
Feel like this lends support to (~surprising) ACR/VF recs for EGPA?
#ACR21 #ACRAmbassador https://t.co/gpsPtXF6pj
Mike Putman EBRheum ( View Tweet)
Why would higher active dose of #methotrexate with sc admin & more metabolites polyglutamates which can give side effects have LESS AEs? Never understood it! #ACR21 abst#1695 @RheumNow https://t.co/qrEKofX1cl
Janet Pope Janetbirdope ( View Tweet)
Post hoc analysis of pooled data from 19 clin trials on SEC & CV risk & systemic #inflammation in PsO, PsA, AS
📌Traditional CV parameters remained stable on all SEC treated grps
📌SEC sig. ⬇hsCRP & NLR
@RheumNow #ACR21 abs1835 https://t.co/iCaGFbXNXn
sheila RHEUMarampa ( View Tweet)
b/tsDMARDs + tumor response in rheum irAEs
Excellent point by @CCalabreseDO @LCalabreseDO:
- despite progression in 5/10, DMARD contribution uncertain (bad cancer)
- without DMARD, ICI would have had to stop
crucial question, prospective study needed
#ACR21 ABST1519 @RheumNow https://t.co/omJnTNVscH
David Liew drdavidliew ( View Tweet)
Autoantibodies are underrated in rheumatic irAEs (?B cells in general), but probably not your usual.
If Ab are of interest, suspect we're going to have to look at non-classical ones
Elegant from @NilashaGhosh @MPostow @got_rheum @lovetolearn27 #ACR21 ABST1520 ABST1521 @RheumNow https://t.co/tLSJOZw1YG
David Liew drdavidliew ( View Tweet)
For patients with inflammatory irAEs, what's your preference of bDMARD/tsDMARD?
(keeping in mind both irAE response and tumor response)
#ACR21 irAE Study Group run by @CCalabreseDO @NAbdelwahabMD @ReidMDMPH
@RheumNow
David Liew drdavidliew ( View Tweet)
Safety profile of #upadacitinib in #RA, #PsA, #AnkylosingSpondylitis
👉🏼AE rates similar across UPA, ADA & MTX in RA, and UPA & ADA in PsA
👉🏼No new safety risks with long-term use
👉🏼#Herpeszoster & incr CPK more common w/ UPA vs ADA/MTX
Abs#1691 #ACR21 @RheumNow https://t.co/tKYi65kB5r
Mrinalini Dey DrMiniDey ( View Tweet)
#ACR21 Ab#1681: ATI-450- MK2 Inhibitor
⭐️Downstream MK2 mediated inflamm drive of p38.
⭐️Hope this would avoid tachyphylaxis in p38 inhibitor meds
▶️Phase2a study in 19 pts: Well-tolerated (SEs: UTI, ventricular extrasystole), good 12 week data
@Rheumnow https://t.co/6lo7zPJUpx
Links:
Eric Dein ericdeinmd ( View Tweet)
SELECT-EARLY results for #upadacitinib in #RA
👉🏼UPA better than MTX for clinical response and remission
👉🏼⬆️rates of HZ, neutropenia, CPK elevations
👉🏼No new safety risks identified
Abs#1692 #ACR21 @RheumNow
https://t.co/wJy7MK4pyF https://t.co/YNpE1Axiw0
Mrinalini Dey DrMiniDey ( View Tweet)
Upadacitinib 56-wk efficacy/safety (mod to severe PsA)
🔹Comparable or ⬆️efficacy vs adalimumab
🔹Efficacy maintained, and 15mg vs 30mg doses similar at 56wks
🔹No new safety findings @ 56wks
🔹🚫inc risk VTE, MACE, cancer vs ada
https://t.co/NlKvBrwDxB
#ACR21 Abst#1345 @RheumNow
Pedro Castillo _Castillo_Pedro ( View Tweet)
