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Opening Day Report
The opening of ACR2 Convergence was a hit for all who signed up and viewed in. The day included the presidential address by outgoing president Dr. David Karp (UT Southwestern) and a keynote talk and interview with Dr. Seema Yasmin (Stanford).
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Emerging Therapies in Spondyloarthritis: A Promising Pipeline
Growing awareness of spondyloarthropathies over the last two decades has led to a better understanding of the pathophysiology of spondyloarthritis, and subsequently increased interest in more distinct, disease state specific treatment options.
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Very interesting talks by Dr. Kim and Dr. Hyrich on DMARDs and Cancer risks
#ACR21 @RheumNow https://t.co/Dl5WPo7mmj
Akhil Sood MD AkhilSoodMD ( View Tweet)
This feels like an excellent starting point for Tuesday's ORAL Surveillance malignancy discussion.
RWE Cohort: HR 1.01 (0.83-1.22)
RCT-dup Cohort: HR 1.19 (0.86-1.64)
ORAL Surveillance: HR 1.48 (1.04-2.09)
Interesting day 4 ahead!
great talk @SeoyoungCKim #ACR21 7S413 @RheumNow https://t.co/YSau21goMr
David Liew drdavidliew ( View Tweet)
#ACR21 #Abstr0871 📢Argument against HCQ<5mg/kg dose from cardiac perspective in #lupus. A retrospective study N=296 pts, 13% developed CV events.⬇️28% in risk of heart failure, arrhythmia/cardiac death per mg/kg of HCQ in non-smokers @RheumNow #ACRBest https://t.co/6ssd2159R1 https://t.co/tllPWLnFFj
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
Baseline/ Clinical /Imaging predictors of flare when tapering TNFI in axSpA in remission:
⭐️🔼Baseline physician global VAS 🔼flare in 16 weeks after tapering to 2/3 of standard dose.
⭐️🔼Age 🔼flare within 16 weeks after tapering to 1/2 dose
Abst #0929 #ACR21 @RheumNow https://t.co/EFiwKA8z99
swethaann23 swethaann23 ( View Tweet)
#ACR21 Abst#0588. TNF vs non-TNFi in obese RA pts
⭐️TNFi use ⬆️ disease activity vs ABA in obese pts
⭐️TNFi use ⬆️ activity vs TCZ in non-obese pts
⭐️No diff w RTX, Tofa
▶️Further research needed: Wt-based dosing? SC vs IV?
https://t.co/K8WycPTgxW @Rheumnow #ACRBest
Links:
Eric Dein ericdeinmd ( View Tweet)
Let's look at MI first.
Well, the numbers don't look great for tofa here.
fatal MI very small numbers
non-fatal MI - well that doesn't look good
(do we have combined both tofa doses vs TNFi?)
HR > 2 seems less than ideal - this would represent a substantial RF
#ACR21 @RheumNow https://t.co/5HSXFrMJCu
David Liew drdavidliew ( View Tweet)
Do you order EKGs in everyone starting HCQ? Do you avoid HCQ in patients with heart failure? Will these abstracts impact your practice? Click on link to read more....#ACR21 @rheumnow #HCQ https://t.co/fvUZAvNWa8
TheDaoIndex KDAO2011 ( View Tweet)
Dr Naovarat reports on 18 year outcomes of HIV and rheumatic disease. 16 patients treated with TNFi, including 2 who switched to tocilizumab and ustekinumab. No major infections. Rising viral load in 1 led to discontinue. Abstr#0965 #ACR21 @RheumNow https://t.co/jcGPaURKmb
Richard Conway RichardPAConway ( View Tweet)
Physician global score only predictor of axSpA flares when tapering TNFi
⭐️Changes in imaging did not predict flare
Abs#929
#ACR21 @RheumNow
https://t.co/vVn6ARKJu0 https://t.co/FlVtlLmTfl
Robert B Chao, MD doctorRBC ( View Tweet)
For rheumatologists, instinct says in RA everything’s better with MTX. For tofacitinib, where immunogenicity not an issue, is that actually true?
Canadian registry data: maybe no
after 36m, low no. ?valid, markups mine
Need to see more of this!
#ACR21 ABST0827 @RheumNow https://t.co/VVwd4SZgVx
David Liew drdavidliew ( View Tweet)
#ACR21 Abst#0786. Fibroscan screening for liver injury in pts on MTX:
▶️No significant correlation between cumulative MTX dose and liver stiffness by fibroscan, even at high dose MTX.
⭐️Age, sex, waist circumference, BMI are risks
@Rheumnow https://t.co/IhcNr9fhEh https://t.co/c7TUoGrNZ7
Links:
Eric Dein ericdeinmd ( View Tweet)
TNFi + JIA = watch the skin! A nearly 3fold increase of paradoxal psoriasis in JIA patients exposed to TNFi reported in the CARRA registry w/ incidence rate the highest on children receiving adalimumab.
#Abst0241 @RheumNow #ACR2021 https://t.co/uXOwV2RlGu https://t.co/8f8mvVUkV2
Aurelie Najm AurelieRheumo ( View Tweet)
Prolonging the Controversy of Hydroxychloroquine
Dr. Kathryn Dao (@KDAO2011 ) shares several abstracts from #ACR21 that addressed the topic of HCQ and cardiovascular safety.
https://t.co/J6sVzYJkUZ https://t.co/dBZmtwQ927
Links:
Dr. John Cush RheumNow ( View Tweet)
Risankizumab (IL-23i) KEEPsAKE 1 and 2 (phase 3) studies for PsA treatment
⬆️ACR20 response compared to pbo
⬆️secondary endpoints
⭐️no new safety signals
Abs#453
#ACR21 #ACRBest @RheumNow
https://t.co/7bwvIPMz38 https://t.co/TJaSqwipa5
Robert B Chao, MD doctorRBC ( View Tweet)
@RheumNow #acr21 abst 195 prospective study of JAKi for refractory Still’s in 7 pts suggests JAKs can be useful as an add on but not in monotherapy : partial response 57%& failure in43%. No patient achieved complete remission. steroids could be decreased by63%~ https://t.co/rYHVReRHvL
Olga Petryna DrPetryna ( View Tweet)
The evolving JAK inhibitor story
Black box Warnings regarding JAK inhibitor use and MACE, malignancy, thrombosis and mortality - full safety data remains to be examined.
@ACRheum #ACRambassador #ACR21 https://t.co/imQ1LSxeXM
Tanmayee Bichile, MD BichileT ( View Tweet)
#ACR21 #ACR2021
Rheumatology Reproductive Health
👉🏻 Biologics and breast milk
👉🏻 Good vaccine response with TNFi (like with covid vaccines )
👉🏻 ustekimumab seems safe in pregnancy
👉🏻 Tofacitinib/ small molecules may cross placenta/ be in breast milk ➡️ contraindicated in preg/BF https://t.co/qk3sLR4QHz
EnvisionRheumat ERheumat ( View Tweet)
COVaRiPad study - Immunosuppression affects COVID-19 vax Ab levels. 247 pts, 90% seroconverted but @ reduced (3.4 fold) titers. Lowest w/ MMF (21x) and B cell Rx vs MTX/AZA (3-4x). Pts on B cell therapy should wait 6 mos to recv vax #ACR21 Abstr# 0457 https://t.co/1gkCsJSDBk
Dr. John Cush RheumNow ( View Tweet)
