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To be continued (or discontinued?): Abstract 2360: Compared to TNFi, IL-17i & JAKi users had 🔹 Higher odds of med switching <180 days 🔹 Shorter time to discontinuation @RheumNow #ACR25 #axSpA https://t.co/IOHaFSJqHn
Akhil Sood MD, MS AkhilSoodMD ( View Tweet)
Interesting study evaluating the "CALLY" index (serum albumin × lymphocyte count / CRP / 10,000) for predicing mortality in AAV
I typically dislike these because (1) they are often cumbersome to calculate & (2) they often perform poorly
This one piqued my interest; pretty https://t.co/ziroQOH5Cq
Mike Putman EBRheum ( View Tweet)
Meta-analysis of 3 RCTs (n=1990) shows IL-17i offers comparable joint response but superior skin clearance vs adalimumab in biologic-naive PsA. IL-17i also had fewer discontinuations due to adverse events. Supports sequencing of biologics through different mechanisms of action in https://t.co/SJgFUMxWVb
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
RESET-RA, RCT of vagus nerve stim (device that zaps pts in neck)
Marginal improvements in ACR20 at wk 12; trend in to improvement in unblinded part of study fwiw
Have never seen result that is more likely to be driven by plbo effect & unblinding 🤪
@RheumNow #ACR25 Abstr#2278 https://t.co/BlR570nv7k
Links:
Mike Putman EBRheum ( View Tweet)
MSK side effects of CAR-T, based on FAERS pharmacovigilance data (also see @DrGomezPuerta in @seminarthrheum https://t.co/LnwjU5aebs) #ACR25 ABST1731 @RheumNow https://t.co/kREEy3HLE9
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David Liew drdavidliew ( View Tweet)
PLEX continues to be OUT for DAH in AAV
Retrospective review of ~1.4k AAV-DAH pt
375 who received PLEX compared to those who did not
PLEX tx patients:
- higher odds of death
- higher sepsis
- increased LOS
- increased hospitalization cost
@RheumNow #ACR25 Abst 2517
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
Mateo Faxas et al. TriNetX study, propensity score matched. 3000 patients. Arrythmia risk is higher with IL-6i vs TNFi in diabetic RA patients. V Tachy (HR 1.4), PPM need (HR 1.4) significantly higher. AF, SVT, VF all numerically increased. @RheumNow #ACR25 Abstr#2283 https://t.co/U2Tk38Mobg
Richard Conway RichardPAConway ( View Tweet)
Molina et al. 52 weeks of MANHATTAN study. Guselkumab vs second TNFi after failure 1st TNFi in PsA. MDA 52% vs 33%. Remission/LDA 67% vs 62%. @RheumNow #ACR25 Abstr#2373 https://t.co/qdtOlKLfNU
Richard Conway RichardPAConway ( View Tweet)
CD19 counts during RTX maintenance therapy do NOT perform well in assessing the risk of relapse
Interestingly, only younger age was associated with relapse in this retrospective study
@RheumNow #ACR25 Abst 1766 https://t.co/crsFKJ0LnP
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
Can AI predict who stops their RA meds?
In older adults on b/tsDMARDs, interpretable ML found frailty, comorbidity & age top the list for nonadherence risk.
@RheumNow #ACR25 Abstract#2287
Jiha Lee JihaRheum ( View Tweet)
Girolami et al. VA study. Safety of DMARDs in RA following melanoma. 644 patients. 3 year all cause mortality. No significant difference, but graph sure looks like b/tsDMARDs are better. No melanoma specific mortality/recurrence data however. @RheumNow #ACR25 Abstr#2237 #ACRBest https://t.co/IN4LDkioT7
Richard Conway RichardPAConway ( View Tweet)
Is RA-ILD associated with/ higher risk of infection?
Retrospective US cohort study
151 RA-ILD
980 matched controls
79% higher risk of any and pulmonary infections in RA-ILD
Pathogen type: bacterial, viral and fungi
Some of these infections are preventable!
Take Home: https://t.co/fPmRjLL7Po
Links:
Aurelie Najm AurelieRheumo ( View Tweet)
In DISCOVER-2, male PsA patients had greater radiographic progression than females despite similar baseline scores. Early joint response (W8 cDAPSA LDA) was linked to less progression more strongly in men. Highlights the sex differences in PsA outcomes. Abstract#2345 @RheumNow https://t.co/zIo59FYPVg
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Does specific ANCA subtype inform infectious risk?
Retrospective review of 270 AAV patients revealed that about 1/3 pt developed severe infections... of these:
- 64.1% MPO+
- 35.9% PR3+
Most infx during year 1 of tx
No difference between CYC vs. RTX
@RheumNow #ACR25 abst 2510
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
Simulation modeling by Patel et al helps generate probability of remission, relapse, and adverse events in newly dx AAV
Projected risk by model were similar to observed rates in RCTs
@RheumNow #ACR25 Abst 1764 https://t.co/xevkJ2Ih0M
Links:
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
HCQ weight-based dosing: out
HCQ whole blood monitoring: in
Whole blood levels more precisely balance risks of SLE flare (under-dosing) vs. toxicitiy (over-dosing)
Many pt on <5 mg/kg had supra-therapeutic blood levels with risk for toxicity
@RheumNow #ACR25 #ACRBest Abst 1722 https://t.co/qIbACxAW39
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
Passive transfer of Ab can occur w #IVIg
#Ab can occur from IVIg passive transfer incl HepB
IVIg - if pt has #cryoglobulins
👇
Can precipitate severe #cryo flare
#ClinicalPearl
Secrets & Pearls session
#ACR25 @RheumNow @ACRheum https://t.co/tTaSuVy1yQ
Janet Pope Janetbirdope ( View Tweet)
#1725 Functional NOTCH4 variants contribute to vasculopathy & fibrosis in SSc, particularly in African-American patients
NOTCH4 hyperactivation disrupts angiogenesis & drives EndoMT; inhibition (including with FDA-approved Nirogacestat) restores vascular repair @RheumNow #ACR25
Mrinalini Dey DrMiniDey ( View Tweet)
#1724 MAIT cells central in RA pathogenesis. These innate-like T cells accumulate in synovial fluid, driving fibroblast activation, cytokine release & joint damage. Blocking MAIT activation or deleting MR1 reduces arthritis in mice- a potential new target in RA. @RheumNow #ACR25
Mrinalini Dey DrMiniDey ( View Tweet)
Pooled data fr diff SLE cohorts by Dr SGarg et al were evaluated to determine an upper threshold tx range of HCQ
750-1150 ng/mL: safe & effective HCQ levels
>1150ng/mL-supratx, no added tx benefit
CKD st >/=3: 2x ⬆️odds of toxic hcq levels
#ACR25 @RheumNow Abs1722 #ACRBest https://t.co/RFx1VO0bov
Links:
sheila RHEUMarampa ( View Tweet)
