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Methotrexate may be a rheumatologist’s best friend, but a key part of counselling any patient about its use has always been the risk of hepatotoxicity.
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The RheumNow faculty reporters have been scouring and reporting on the best abstracts from the ACR. Here is a sampling of their choice abstract presentations reported during ACR 2020 Day 2 (#ACRbest).
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The first full day of Abstracts and Presentations from ACR Convergence, was full of highly engaging sessions, quality posters and unique presentations. To hear more about the best of the best, I would encourage you to look at our Day 1 Recap Video and Day 1 ACR Best Abstracts. Here are a few of my favorites from the first day.
TheDaoIndex
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👉HCQ dose < 400 mg/d are assc with SLE flare. Lower doses of HCQ may decrease risk of retinopathy. 👉For >80 kg (176 lbs), any dose < 400 mg/day is assc with increased odds of flare
(HCQ blood levels not measured)
Abst#1462 #ACR21 @rheumnow https://t.co/5tx3kruT8W
TheDaoIndex
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@ericdeinmd Although the MTX/alopecia - nausea poster was interesting. Abst#1444 #ACR21
Factors assc w/MTX- nausea/alopecia:
👉female sex
👉EtOH use
👉higher disease activity
👉belief that the med will cause it
(older age assc w/⬇️risk of nausea) https://t.co/XDKFhvN0V1
@rheumnow
Eric Dein
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#ACR21 Ab#1444 @AhmadSherbini. Factors ass w/ nausea & alopecia in MTX
⭐️Nausea & alopecia: ♀️, 🥃, activity score are risk factors
▶️EtOH highlights importance of folic acid in these pts!
@Rheumnow https://t.co/6UNUVh5ZW8 https://t.co/lxB2z2lXtu
Janet Pope
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Love-hate relationship with #methotrexate. Side effects are common ex nausea/GI in 1/3 and alopecia in women. ?if you ask do you get more AES. Tough to treat especially SEs are early. ?Coach pt to help w persistence abst1444# @RheumNow #ACR21 https://t.co/NDQDVz8lk2
Olga Petryna
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Abst1344 #ACR21 @RheumNow observational study of pts w/PsA treated w/b&tsDMARD:pts who achieve MDA (22.8% of pts at 6 mo) more likely to maintain the initiated bDMARD or tsDMARD Rx & less likely to switch from the initiated bDMARD/tsDMARD https://t.co/egFDHV3eQs
Janet Pope
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#volcosporin good ~lupus nephritis added to #MMF but underbelly - side effects like but ?less than #cyclosporin. #FDA update - ⬆️hypertension and nephrotoxicity, infection #ACR21 @RheumNow https://t.co/w5nLLSTlrB
TheDaoIndex
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"Baseline and routine EKGS are NOT required for SLE patients just because they are on HCQ!" - Dr. HM Belmont. "The drug has been demonized due to its use in COVID patients. We don't need to hold HCQ for EMR alerts (e.g, with cipro, SSRIs, etc)." Abstr#1743 #ACR21 @rheumnow https://t.co/5Bxavo6dRg
Robert B Chao, MD
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Post-hoc analysis of Deucravacitinib (TYK2i) for tx of PsA showed similar efficacy in pts with and without background csDMARD use.
⭐️>60% w/ background csDMARD use, majority of which was MTX
⭐️no difference in AE
#ACR21
Abs#1352
@RheumNow
https://t.co/nIJT7rNkJP https://t.co/bq0x1Ywguo
Mrinalini Dey
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What predicts response to MTX in RA?
👉🏼DAS28-ESR
👉🏼RA duration
👉🏼Pt global assessment
👉🏼Swollen joint count
Abs#1227 #ACR21 @RheumNow
https://t.co/s942zvFiZ1
Md Yuzaiful Md Yusof
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#ACR21 #Abstr1420 A study checking #COVID vaccine response in 90 #lupus pts and 20 HC:
⬇️Titres of Abs in SLE vs controls
💠Factors of poor response: On any DMARDs exc HCQ only (OR 15) and normal dsDNA
📢Important to pause DMARDs in stable SLE @RheumNow https://t.co/USovFkiCRb https://t.co/bn5CC0xRS9
Dr. John Cush
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Fautrel describes a series of 13 #AOSD (Stills) pts with Pulmonary arterial HTN (cath confirmed) - seen exclusively with women, 85% and all were on DMARDs - 31% MTX, 69% IL-1i, all on steroids- 5 deaths, 3 yr Survival 74% (same as PAH) #ACR21 Abstract 1100 https://t.co/qR21MdYG3A https://t.co/WN38ifgtT6
Eric Dein
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#ACR21 Abs#1224. ⬇️ CD39 expression on B cell predicts occurrence of anti-drug Ab in RA on RTX
⭐️13/23 pts on RTX became ADAb+. No diff in concomitant MTX usage
⭐️Baseline CD73 similar, but lower CD39 predictive of ADAb
https://t.co/QzbAmXtTmZ @Rheumnow https://t.co/CLtEev69YD
David Liew
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Atypical patterns of HCQ retinopathy:
- outside the central macula
- missed by standard central macula screening
- 41x more likely in Asians!
Lesson: screening with extramacular SD-OCT for Asian HCQ pts is so, so important. 41x over.
@MGHrheumatology #ACR21 ABST0989 @RheumNow https://t.co/0w7ALHJDSW
Akhil Sood MD
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Another exciting day at #ACR21 and covering for @RheumNow
Also presented my poster (Abstr 0587) DMARD Use in Medicare Patients with #RheumatoidArthritis and Risk of Long-Term Opioid Use
- DMARD users showed lower odds of long term opioid use compared to non-DMARD users https://t.co/2XZgYY8ORg
Pedro Castillo
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Stopping/reducing hydroxychloroquine (HCQ) in SLE associated with increased flares, especially for those in low disease activity or in remission. Super helpful data to share with pts wanting to reduce/dc HCQ.
#ACR21 Abst#0959 Plenary Session II @RheumNow https://t.co/i7jPDN2sgZ
Janet Pope
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How concerned should we be for #hydroxychloroquine retinopathy. >4000 pts prospectively followed. 1/2 w RA & 15% w #SLE. New risks Asian with pericentral pattern and overall. Length of time on use and ⬆️wt based dose per day & CKD all risks. Abst#0989 #ACR21 #ACRBest @RheumNow https://t.co/XTfdQpVC7H
David Liew
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In pts w/o RF, liver bx prev suggestd if lifetime cumulative MTX dose was 1-1.5g, then 3.5-4g.
All pts in centre offered Fibroscan
liver stifness associations:
- age, BMI
- not cumulative MTX dose
maybe survival bias, but what we're doing now is fine!
#ACR21 ABST0786 @RheumNow https://t.co/I6IhS3jhmC
