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EULAR 2024 – Day 4 Report
The final day of EULAR 2024 was rich in posters, Late-breaking oral presentations and EULAR updates and recommendations. Below is a synopsis of the half-day's action.
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Update on low-dose glucocorticoids in SLE
Glucocorticoids (GC) have been the mainstay of treatment in SLE for nearly three quarters of a century. GC induce a range of anti-inflammatory effects, quickly relieve some symptoms and lower mortality in some life-threatening flares. However, they also have multiple side effects that limit the duration of treatment, as well as the dose used. Accordingly, the 2023 EULAR recommendations for SLE set a target dose of ≤5mg/day. Is low dose GC an achievable target?
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Upside/Downside of Steroids in Lupus Nephritis
A systematic review of randomized clinical trials of patients with biopsy-proven lupus nephritis (LN) demonstrates both the benefits and harms to early glucocorticoid (GC) regimens on lupus outcomes.
"Don't You Know Who I am?" (5.17.2024)
Dr. Jack Cush reviews the news and journal reports from the past 2 weeks. This week's question: can we prevent gout, ILD or psoriasis?
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Update on low-dose glucocorticoids in SLE
GC have been the mainstay of treatment in SLE for nearly 75 yrs. GC induce anti-inflammatory effects, quickly relieve symptoms, and reduce mortality in life-threatening flares through various actions.
https://t.co/uEtWftvwEz https://t.co/nJlpELMj5W
Dr. John Cush RheumNow ( View Tweet)
Voclosporin and Steroids in Lupus Nephritis
Dr. Jack Cush reports on abstract OP0059 presented at Eular 2024 in Vienna, Austria.
https://t.co/y9QPieV0py https://t.co/GzwntEJLve
Dr. John Cush RheumNow ( View Tweet)
PMR patients get too much steroid.
Data across 27 million people in England, n=39,438 with PMR.
The blue are getting more pred than guidelines.
Like everything in rheum: we need to be giving less pred, not more. Lumping PMR in with GCA won’t help.
#EULAR2024 POS0411 @RheumNow https://t.co/bsi3lrAafm
David Liew drdavidliew ( View Tweet)
Steroids are often started before pts see a rheumatologist
This associates with long-term low-dose steroid use
Need better collaboration between referrers and rheum to reduce this avoidable steroid burden
POS0137 @RheumNow #EULAR2024
Mrinalini Dey DrMiniDey ( View Tweet)
« Glucocorticoids are such old drugs and we still use them so much » says Josef Smolen
Summary slide from « 75th anniversary of GCd, what have we learnt? »
@RheumNow #EULAR2024 https://t.co/XSRt44zupw
Aurelie Najm AurelieRheumo ( View Tweet)
EULAR guidelines for screening for TB in rheumatic disease patients
#EULAR2024 https://t.co/jaixl8lGkY
Jilaine Bolek Berquist BolekBerqui ( View Tweet)
POS0277: proof of concept: Prophlx with canakinumab x 1 dose rather than steroids/colch/NSAIDS when starting pegloticase with MTX in pts with active, refractory gout: 11 pts: #gout flares 0 (compared 54% in MIRROR-C), infusion rxn 0, no safety signal @rheumnow https://t.co/4qFnQTOuq0
TheDaoIndex KDAO2011 ( View Tweet)
The fracture risk with glucocorticoids is dose dependent. Lems W #EULAR2024 @RheumNow https://t.co/TGjKu1vfXx
Dr. Antoni Chan synovialjoints ( View Tweet)
I was allocated to bring down the warning, & I did apologise up front to both the EMA and Janet #EULAR2024. It's a tough gig regulating impactful medicines with risk-benefit, especially when our world is full of other medicines with risk-benefit trade-offs (like prednisolone). 2/ https://t.co/6YPhYHbhg8
Links:
David Liew drdavidliew ( View Tweet)
#EULAR2024 OP0124 EULAR recommended target oral Pred =<5mg/d. Should the threshold of LLDAS be changed to LLDAS5? Multicentre study showed the protection gained from mortality, irreversible organ damage accrual and flare was no different btw the two targets @RheumNow #EULARBEST https://t.co/GbP25tTmX8
Links:
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
#EULAR2024 OP0180 Can we safely taper GC in #lupus patients who are in remission? Single study in Italy showed in pts with SLEDAI=0 + pred =<5mg/d + stable IS/HCQ, GC discontinuation after proper tapering appeared safe and was associated with a low risk of flare @RheumNow https://t.co/8IIgPuZUrF
Links:
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
OP0165- incidence & risk factors of D2T RA in an early RA cohort
Factors assoc with D2T RA:
🩸 Seropositivity
🦴 Erosions
📈 Disease activity
📊 D2T pts have higher steroid doses & more commonly develop iatrogenic-related #comorbidities, e.g. osteoporosis
#EULAR24 @RheumNow
Mrinalini Dey DrMiniDey ( View Tweet)
Can you ⬇️
#Glucocorticoids or #immunesuppressive in #SLE & change am’t of damage
From Asia Pacific #lupus collab
(Biologics not included)
Compared 7.5 mg #prednisone or less
Or DMARD
1/2 flared after LLDAS
⬇️dose didn’t prevent damage
#EULAR2024
@eular_org @RheumNow https://t.co/QmjEz87Cvw
Janet Pope Janetbirdope ( View Tweet)
GC treatment duration for <90 and 90 to 360 days is associated with a higher risk of cumulative SI compared to nonexposed, especially the first year but also up to two years since first visit in RA patients. Maximum RR for <90 days is observed at 8 months since first visit (RR:… https://t.co/ecK2ylqrRk https://t.co/IQ5QQjExYQ
Links:
Dr. Antoni Chan synovialjoints ( View Tweet)
🌎 Global disparities in steroid prescribing in #SLE
💊 HCQ assoc with decreased steroid use
📈 Other contributing factors may be prevalence, severity & phenotype of disease, plus access to DMARDs & biologics
📍SLE poster tour 15:30 TODAY
#EULAR2024
Abs #POS0013
@RheumNow https://t.co/7pL8kpeqOs
Mrinalini Dey DrMiniDey ( View Tweet)
Medicare & Optum claims data study of 2851 #RA pts w/ breast cancer (BC). In 3 mos before BC 27028% received bDMARDs. W/in 1st 3 yrs post-BC Dx 24-26% were receiving bDMARDs. 70% of RA pts on steroids without change w/ time https://t.co/51NcXv0xyc https://t.co/461NZiFvDO
Dr. John Cush RheumNow ( View Tweet)
