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The Need for Comparative Treatment Trials in Psoriatic Arthritis

Richard Conway, MBBChBAO, PhD

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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ACR Best

ACR21 Best Abstracts We Saw - Day 3 (Monday)

Jack Cush, MD

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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Cush ACR learning computer online

Day 2 Report from ACR21

Jack Cush, MD

This report highlights the VITAL trial; the ORAL Surveillance Study; and the Microbiome study of monozygotic psoriasis patients.

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Methotrexate and hepatic fibrosis: we must be doing something right

David Liew, FRACP

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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Slot,Machine,Jackpot

After failing a JAK inhibitor, can you still hit a JAK-pot?

Eric Dein, MD

Januse kinase (JAK) inhibitors are targeted synthetic disease modifying anti-rheumatic drugs (tsDMARDs) that have risen in popularity as earlier treatment options for rheumatoid arthritis.

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ACR Best

ACR21 Best Abstracts - Day 2

Jack Cush, MD

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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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

Links:

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

Links:

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

Links:

Pedro Castillo _Castillo_Pedro ( View Tweet)

🆕 Updated 2021 ACR Guidance for Adjusting Immunomodulatory Therapy with the COVID-19 Vaccine in Patients with Rheumatic & MSK Diseases Discussed at #ACR21 COVID-19 Hub! V4 Link: https://t.co/1SOR9yTQyF https://t.co/PKFKXpLofN

Links:

Mithu Maheswaranathan, MD MithuRheum ( View Tweet)
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
David Liew drdavidliew ( View Tweet)
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
Janet Pope Janetbirdope ( View Tweet)
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
David Liew drdavidliew ( View Tweet)
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