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ACR 2024 - Day 2 Report
Plenary sessions began the day, followed by thousands on the abstract floor. Here are a few of my favorite presentations from day 2 at ACR 2024.
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Should you worry about giving TNFi to RA pts after a cancer diagnosis?
Medicare data with colorectal, lung, prostate Ca:
TNFi pts survival no worse (numerically better) than csDMARDs
Cancer pts deserve good RA treatment!
#ACR24 ABST0202 Suarez-Almazor @MDAndersonNews @RheumNow https://t.co/w58MNqRt1T
David Liew drdavidliew ( View Tweet)
Effective RA therapy is about more than just joints
🇪🇸 RA cohort
TNFi for first 24w led to:
Lean mass index i.e. muscle going up
Fat mass index i.e. fat trending down
Muscle & fat composition are important
Systemic Rx can deliver systemic benefits
#ACR24 ABST1348 @RheumNow https://t.co/mZjcHwxMgW
David Liew drdavidliew ( View Tweet)
Steroids in checkpoint inhibitor rheumatic irAEs need to be approached with caution.
Persistent higher doses earlier on might dampen ICI response.
@HSpecialSurgery ICI-IA (inflamm arthritis) cohort
big diff in survival based on early steroid exposure
#ACR24 ABST1989 @RheumNow https://t.co/3WAZ3ZLbFw
David Liew drdavidliew ( View Tweet)
Here's a meta-analysis of MACE/malignancy in JAKi vs TNFi in observational cohort studies.
All the epidemiological challenges here aside, it's a good reminder that with ORAL Surveillance it's *cardiovascular risk enriched pts* we're concerned about.
#ACR24 ABST2264 @RheumNow https://t.co/vIXlrI3V2d
David Liew drdavidliew ( View Tweet)
RA patients on TOF with h/o ASCVD have 4x higher risk of MACE without statin (vs. TNFi).
Prioritize statins for heart health in RA!
#ACR24 @RheumNow ABST#1745 https://t.co/jRqXNU2T6d
Links:
Jiha Lee JihaRheum ( View Tweet)
The odds of axSpA patients developing fractures was lower among those on TNFi vs DMaRDs or NSAIDs accdg to this study by NGeorge et al.
axSpA pts are at high risk of fractures & drugs that mitigate these risks are important. More robust data are needed
@RheumNow #ACR24 abs1439 https://t.co/ZSV3og5N5x
sheila RHEUMarampa ( View Tweet)
A#1745
Post-hoc ORAL Surveillance - statin
<1/4 on a statin, only 53% h/o ASCVD on statin
Incr in LDL was less on Tofa pts on statin
Among those on b/l statins, there is no incr risk compare to TNFi, esp pts h/o ASCVD
If high risk on tofa, statin helps!
@RheumNow #ACR24 #ACRBest https://t.co/7MGgUk7tfI
Links:
Eric Dein ericdeinmd ( View Tweet)
In a cohort of >17,000 European pts w/ axSpA:
-bDMARD naïve pts starting TNFi or IL-17Ai were more likely to achieve LDA than TNF-experienced.
-Higher time to achieve LDA and shorter durability in pts with prior TNFi use.
Abst#1756 #ACR24 @RheumNow
Adela Castro AdelaCastro222 ( View Tweet)
Subgroup data from SELECT GCA, overall reinforces overall message
I was curious to see pts previously treated with TCZ; wonder if that selects for refractory phenotype - seems not to be the case
Take home: encouraging data, no subgroup issues
#ACR24 @RheumNow Abstr#1695 https://t.co/5iCLE6T4u3
Links:
Mike Putman EBRheum ( View Tweet)
Gonzalez Molina et al. MANHATTAN observational study. In PsA after 1st TNFi failure should we use guselkumab or 2nd TNFi? Guselkumab slightly better persistence, DAPSA, and improvements in joint counts. @RheumNow #ACR24 Abstr#1469 https://t.co/X3TMCVys6B https://t.co/vvkUYbzVDq
Links:
Richard Conway RichardPAConway ( 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)
Kharouf et al. Secondary biologic failure in PsA common - 36% over 5 years. Predictors - higher baseline SJC HR 1.39 and PASI HR 1.14. TNFi did better, HR 0.40, esp golimumab - but ?this as often used as first bDMARD? @RheumNow #ACR24 Abstr#1455 https://t.co/ET0WX6tKMr https://t.co/iVcCkM0hu3
Links:
Richard Conway RichardPAConway ( 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)
Koc et al. STAMP trial in PsA. Secukinumab+MTX+GC vs MTX+GC(+SSZ if needed). Both could go to TNF if needed. Secukinumab significantly better at week 12 but no longer at week 24. @RheumNow #ACR24 Abstr#1457 https://t.co/4TGSiUPebV https://t.co/eAANkYIpzy
Links:
Richard Conway RichardPAConway ( View Tweet)
Abst #1473 evaluated association of SJC in PROs from 2 Bimekizumab trials (bDMARD naïve vs TNFi-IR)
-bDMARD naïve had less SJC at baseline
-In both groups, pts w lower SJC had sustained improvement in pain and fatigue over time.
#ACR24 @RheumNow https://t.co/zwxsSbga7c
Adela Castro AdelaCastro222 ( View Tweet)
Are biosimilar multi-switches an issue?
real world data: DANBIO 🇩🇰
biosimilar to biosimilar switch
having already had a switch prior ('previous ADAo') did not increase cessation
The risk of biosimilar switching on immunogenicity is greatly overstated
#ACR24 ABST1000 @RheumNow https://t.co/1yAfZrrNd0
David Liew drdavidliew ( View Tweet)
Single centre experience of belimumab at @GSTTnhs
@RheumNow #ACR24 https://t.co/c4jlEPRwen
Mrinalini Dey DrMiniDey ( View Tweet)
#2282
🔬 Personalised Approach to TNFi in RA
📊 N=50👇; 43 responders
🔑 Findings
💥TNFR2 rs1061622 polymorphism linked to TNFi response
💥 MR/RR alleles ⬆️ 10X odds non-response v. MM allele (OR = 10.1,p=0.04)
🎯Genotyping may guide personalized RA therapy.
#ACR24 @RheumNow https://t.co/MQKZUCEPxj
Caoilfhionn Connolly CaoilfhionnMD ( View Tweet)
#1474
🔬Severe PsA? Guselkumab (GUS) has promise!
➡️In bionaive pts with severe disease activity,
GUS v. PBO resulted in:
🔴73% improvement in joints
🔴53% lower disease activity
🔴63% better PtGA by 2 years
➡️Rapid results by W2, sustained through W100.
#ACR @RheumNow
Caoilfhionn Connolly CaoilfhionnMD ( View Tweet)
