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"EGPA is a lot like peanut butter and jelly, two separate things showing up at the same time (in terms of respiratory and systemic manifestations.)" Dr. @philseo at #RNL2024 @RheumNow https://t.co/l0WgG1caN0
Dr. Rachel Tate uptoTate ( View Tweet)
“Patients with EGPA are like peanut butter and jelly … 2 different manifestations: respiratory manifestations and systemic manifestations” - Dr. P Seo with lunch on his mind. #RNL2024 @rheumnow https://t.co/y7SLEG9qRt
TheDaoIndex KDAO2011 ( View Tweet)
Dr. P Seo's Pearls for #Vasculitis:
1. Weekly or q2weeks SC TCZ is fine for newly diagnosed patients, but if pts relapse, use weekly TCZ.
2. oral steroids perform fine (no need to do IV pulse) even in pts with vision changes
3. taper steroids over 3-4 months
@rheumnow #RNL2024
TheDaoIndex KDAO2011 ( View Tweet)
The great unknown with tocilizumab in GCA, do you stop, how do you stop, etc. @philseo approach. I'm not as brave! Usually park at every other week dosing @RheumNow #RNL2024 https://t.co/y7mg57mWND
Richard Conway RichardPAConway ( View Tweet)
Do you have GCA patients on low dose prednisone? Feel reassured.
Dr. @philseo provides data showing that low dose prednisone may be helpful in remission maintenance. #RNL2024 @RheumNow https://t.co/oyOsczfkfv
Dr. Rachel Tate uptoTate ( View Tweet)
Interesting nuance from @philseo re tocilizumab in GCA. For new onset disease, it may be appropriate to use every other week tocilizumab @RheumNow #RNL2024 https://t.co/moCvpQSkq0
Richard Conway RichardPAConway ( View Tweet)
Do you need to pulse steroids in GCA?
ACR 2022 abstract#0459 data says oral only may be sufficient
Oral vs IV MP - p=0.621
Still favor IV in severe cases
@philseo #RNL2024 @RheumNow
Eric Dein ericdeinmd ( View Tweet)
Amaurosis fugax is not the only vision symptoms to assess in patients with #GCA. Blue vision, double vision (if patients have to look at you in a side gaze prevent double vision) may also be present - Dr. P Seo @rheumnow #RNL2024 https://t.co/AhQnOJF7fa
TheDaoIndex KDAO2011 ( View Tweet)
#RNL2024 @RheumNow
@philseo: I now give Tociliizumab for nearly all patients with GCA
GiACTA shows we weren't doing well enough with steroid monotherapy
GiACTA shows dosing frequency does not make a big difference in new diagnosis, but makes a difference in relapsing disease https://t.co/JBgUQtZSAr
Eric Dein ericdeinmd ( View Tweet)
When thinking of GCA there are only 2 questions you need to ask. Dr. @philseo reminds us to
1. Establish if new or recurrent disease
2. Assess for presence of visual symptoms
#RNL2024 @RheumNow https://t.co/MGML3EafPu
Dr. Rachel Tate uptoTate ( View Tweet)
How I do it, treatment of CGA with Dr. @philseo, who thoughtfully paused so everyone could take a picture of this slide knowing full well it was already at our fingertips! Such a gentleman!
#RNL2024 @RheumNow https://t.co/8kqacqkRM6
Dr. Rachel Tate uptoTate ( View Tweet)
Dr. Phillip Seo contemplates if Taylor and Travis had vasculitis, surely the dose for each would not be the same. Wish you were here @rheum_cat to weigh in on this. #RNL2024 @rheumnow https://t.co/1ynctgIknx
TheDaoIndex KDAO2011 ( View Tweet)
In case you needed any more reasons why @philseo is the best @rheum_cat , this is his first slide @RheumNow #RNL2024 https://t.co/Ar0v7sQuuX
Richard Conway RichardPAConway ( View Tweet)
Dr @anisha_dua's takehome points for treating GPA in 2024
*RTX and CYC are both effective followed by RTX at least 500mg q 6 mo for at least 2 years
*PLEX not generally used, but may be effective in preventing ESKD
*Rapid GC tapering may not be suitable for all pts
*Avacopan is… https://t.co/haI19Sgpmu https://t.co/jhjXLwd0Uw
Links:
Dr. Rachel Tate uptoTate ( View Tweet)
PJP prophylaxis in GPA. Always a trade off but these things are not created equal. PJP or sepsis are much worse on average than the AEs @anisha_dua @RheumNow #RNL2024 https://t.co/9sECd7fSRk
Richard Conway RichardPAConway ( View Tweet)
Remission maintenance in AAV. First 2 years is clear - fixed dose RTX is superior. After that it is clear that following ANCA is suboptimal, could consider either B-cell return dosing or ongoing fixed dosing @anisha_dua @RheumNow #RNL2024 https://t.co/0Elir88L9U
Richard Conway RichardPAConway ( View Tweet)
Maintenance issues in GPA. Clear messages. 1. RTX is best 2. Fixed 6-monthly RTX best for 1st 2 years. 3. Don't stop RTX at 2 years! @anisha_dua @RheumNow #RNL2024 https://t.co/jS3jWm0CcS
Richard Conway RichardPAConway ( View Tweet)
The answer to "always" is "always" no, correct? PEXIVAS low dose is a great baseline plan, but always adjust in light of the individual patient both upfront and especially if things aren't working out @anisha_dua @RheumNow #RNL2024 https://t.co/RPnpAdB1eG
Richard Conway RichardPAConway ( View Tweet)
Rapid GC taper in ANCA vasculitis
#RNL2024 @RheumNow
@anisha_dua
PEXIVAS - reduced GC is safe, decreased ifns
Retrospective real world - 234 pts. Reduced dose GC+RTX increased death/ESKD HR 2.42. No difference in infections https://t.co/SWIUSyVbWb
Eric Dein ericdeinmd ( View Tweet)
Great talk @anisha_dua re:AAV, solid updates on mgmt decisions
Looking forward to debating this study with @lastwalsh w/@MatsJunek moderating... @TerrierBen any updates on when your RWD study will be published?
@RheumNow https://t.co/ywVaOIp2WJ
Mike Putman EBRheum ( View Tweet)