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Are Emulation Trials a Fantasy?
Are emulation ‘trials’ helpful, despite the biases that occur with observational data, or do they truly mimic the results of randomized controlled trials (RCTs)?
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Evaluation of Bimekizumab in PsA
Bimekizumab (BKZ) is a monoclonal IgG1 antibody that selectively inhibits interleukin (IL)‑17A and F. There have been more updates on the 2 year data on BKZ at #ACR24, and this is a summary of four studies being presented this year at ACR24.
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Improved fertility in women with RA when treated with a Treat-to-Target (T2T) approach aimed at remission.
Key findings:
- Shorter time to pregnancy (TTP) in PreCARA cohort (84 days) vs. PARA cohort (196 days).
- Increased TNF-inhibitor use and lower NSAID/prednisone use in the… https://t.co/YyD2lpXVRC https://t.co/LH5LMOH8al
Links:
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
The post hoc analysis of the SURPASS study evaluated predictors of radiographic spinal progression in axial spondyloarthritis patients treated with IL-17A (secukinumab) or TNF inhibitors over 2 years.
Key findings:
- New syndesmophytes: 18.2% (SEC 150 mg), 15.8% (SEC 300 mg),… https://t.co/jke6OHdPjZ
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Race of b/tsDMARDs in RA, the “JAK-pot” study.
JAKi and TNFi with more rapid early improvement in CDIA, HAQ, and pain compared to ABA or IL-6 inhibitors…..although effects blunted after adjusting for patient and RA characteristics
#ACR24 @RheumNow ABST#0501 https://t.co/8M4wX3LAbW
Jiha Lee JihaRheum ( View Tweet)
Abstract #0805
Data from OTIS Registry shows Certolizumab pegol (Cimzia) exposure during pregnancy was not associated with increased risk of major birth defects, structural defects, or adverse pregnancy outcomes. #ACR24 @RheumNow
Akhil Sood MD AkhilSoodMD ( View Tweet)
Is it safe to administer rotavirus vaccine to infants exposed in utero to TNFi?
Abstract#0806 shows no significant ↑ in the risk of diarrhea-related healthcare events among TNFi-exposed infants who received the vaccine compared to those who did not
@RheumNow #ACR24 https://t.co/HpTCgywE4H
Akhil Sood MD AkhilSoodMD ( View Tweet)
❔Can rheum drugs have beneficial effects on cognition?
💊Possible benefits with MTX and TNFis but certainly an active area of research and more studies needed
#ACR24 @RheumNow https://t.co/lCnIRLwNjK
Mrinalini Dey DrMiniDey ( View Tweet)
Switching vs cycling - which is better? In PsA & axSpA, a real-world analysis shows that switching to IL-17Ai after TNFi discontinuation may lead to similar or better outcomes compared to cycling to another TNFi. Data from the CorEvitas PsA/SpA Registry. Abstr#0585.… https://t.co/AJP4NBjmzr
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Courvoisier et al. JAK-pot study analysis. Which therapies work quicker in RA? JAKi (as expected) and TNFi (what!?) faster than IL6 and abatacept. @RheumNow #ACR24 Abstr#0501 https://t.co/7DPPwHlqpP https://t.co/3mOJ62hZhp
Links:
Richard Conway RichardPAConway ( View Tweet)
#0585 🔬PsA/axSpA: TNFi Cycling v IL-17Ai Switch
➡️470 pts: Switchers to IL-17Ai had similar/better outcomes v TNFi cyclers @ 6 mo
➡️PsA: Switchers had improved arthritis/psoriasis(-5.0, p=0.02)
➡️axSpA: Switchers had improved fatigue(-9.4, p=0.01)
#ACR24 @RheumNow
Caoilfhionn Connolly CaoilfhionnMD ( View Tweet)
Serrano-Combarro et al. Abatacept in RA-ILD. 343 patients. In 23.3% ILD progressed on abatacept. Is that good or bad? We need comparative studies! @RheumNow #ACR24 Abstr#0475 https://t.co/nUEDdjGguA https://t.co/sXEF72MafK
Links:
Richard Conway RichardPAConway ( View Tweet)
PRO-SPIRIT trial data on 1192 PsA pts showed IL-17Ai seemed better than IL-12/23i and IL-23i improving cDAPSA at 3m and as effective as TNFi and JAKi. No much differences seen at 12m. Abst#0076 #ACR24 @RheumNow https://t.co/dScwsmkDOe
Adela Castro AdelaCastro222 ( View Tweet)
With many treatments for #PsA and #PsO, what are the prescribing trends?
Abstract 0604: TNF inhibitors remain the most common (~60%), but over the past 10 years, IL-17i use rose from 0.2% to 19%, and IL-23i from 0.1% to 39.7%! #ACR24 @RheumNow https://t.co/4TnCAkHfuY
Akhil Sood MD AkhilSoodMD ( View Tweet)
Cool data from the JAK-POT study
Have heard JAKs faster than TNF; perhaps not the case!
If anything, TNFs outperformed the others in this study
Trying not to over-read this, but supports my re-emerging preference for TNF
#ACR24 @rheumnow Abstr#0501 https://t.co/NDyPwju3ds
Links:
Mike Putman EBRheum ( View Tweet)
🤨To cycle or not to cycle TNFi. Abst#0585 studied pts with PsA and axSpA with primary TNFi failure:
-Switching to IL17Ai may benefit phGA for arthritis and psoriasis in PsA pts and fatigue in axSpA pts. @AlexisOgdie
#ACR24 @RheumNow https://t.co/Jc0cdmrVhI
Adela Castro AdelaCastro222 ( View Tweet)
#0501
💥 JAKi & TNFi show faster short-term RA improvement (3months) compared to IL-6i & ABA
➡️n=9590(3049 JAKi, 4606 TNFi, 1284 IL-6, 651 ABA), 14 registers
🕒 JAKi, TNFi improved CDAI, pain, function in 1st two months then stabilised
💡Long-term data needed #ACR24 @RheumNow https://t.co/4yzeAAkGjq
Caoilfhionn Connolly CaoilfhionnMD ( View Tweet)
TNFi cycling vs. switching to IL-17Ai?
Dr @AlexisOgdie et al from CorEvitas registry:
PsA & axSpA cohort - switchers (TNFi to IL17i) had greater improvements in cDAPSA & BASDAI vs. cyclers (2nd TNF)
Not stat significant but offers alternative Tx options
@RheumNow #ACR24 abs585 https://t.co/8m347BRM75
sheila RHEUMarampa ( View Tweet)
#obesity causes a lot of diseases including #arthritis. How?
⬆️ IL-6
⬆️ leptin
⬆️ TNF-a
@RheumNow #ACR24
@rheumarhyme https://t.co/qeqTZUOEZy
sheila RHEUMarampa ( View Tweet)
What agent to pick after a TNFi has failed: another TNFi or a non-TNFi?
Would a TNFi drug conc help (i.e. if low, increased clearance due to secondary failure)?
In this RCT @maartenskliniek, this TDM approach was no better than random selection. Argh
#ACR24 ABST0533 @RheumNow https://t.co/3h8o4ARZG3
David Liew drdavidliew ( View Tweet)
