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In case you needed any more reasons why @philseo is the best @rheum_cat , this is his first slide @RheumNow #RNL2024 https://t.co/Ar0v7sQuuX
Richard Conway RichardPAConway ( View Tweet)
Dr @anisha_dua's takehome points for treating GPA in 2024
*RTX and CYC are both effective followed by RTX at least 500mg q 6 mo for at least 2 years
*PLEX not generally used, but may be effective in preventing ESKD
*Rapid GC tapering may not be suitable for all pts
*Avacopan is… https://t.co/haI19Sgpmu https://t.co/jhjXLwd0Uw
Links:
Dr. Rachel Tate uptoTate ( View Tweet)
PJP prophylaxis in GPA. Always a trade off but these things are not created equal. PJP or sepsis are much worse on average than the AEs @anisha_dua @RheumNow #RNL2024 https://t.co/9sECd7fSRk
Richard Conway RichardPAConway ( View Tweet)
Remission maintenance in AAV. First 2 years is clear - fixed dose RTX is superior. After that it is clear that following ANCA is suboptimal, could consider either B-cell return dosing or ongoing fixed dosing @anisha_dua @RheumNow #RNL2024 https://t.co/0Elir88L9U
Richard Conway RichardPAConway ( View Tweet)
Maintenance issues in GPA. Clear messages. 1. RTX is best 2. Fixed 6-monthly RTX best for 1st 2 years. 3. Don't stop RTX at 2 years! @anisha_dua @RheumNow #RNL2024 https://t.co/jS3jWm0CcS
Richard Conway RichardPAConway ( View Tweet)
The answer to "always" is "always" no, correct? PEXIVAS low dose is a great baseline plan, but always adjust in light of the individual patient both upfront and especially if things aren't working out @anisha_dua @RheumNow #RNL2024 https://t.co/RPnpAdB1eG
Richard Conway RichardPAConway ( View Tweet)
Rapid GC taper in ANCA vasculitis
#RNL2024 @RheumNow
@anisha_dua
PEXIVAS - reduced GC is safe, decreased ifns
Retrospective real world - 234 pts. Reduced dose GC+RTX increased death/ESKD HR 2.42. No difference in infections https://t.co/SWIUSyVbWb
Eric Dein ericdeinmd ( View Tweet)
Great talk @anisha_dua re:AAV, solid updates on mgmt decisions
Looking forward to debating this study with @lastwalsh w/@MatsJunek moderating... @TerrierBen any updates on when your RWD study will be published?
@RheumNow https://t.co/ywVaOIp2WJ
Mike Putman EBRheum ( View Tweet)
Contrasing ACR/VF and EULAR GPA guidelines from @anisha_dua @RheumNow #RNL2024 https://t.co/RLJx9fJHGk
Richard Conway RichardPAConway ( View Tweet)
"Real world studies: When people stop being polite and start getting real." Dr @anisha_dua #RNL2024
Comparing Walsh to Nagle in terms of primary outcomes, regimens, pt populations, and plasma exchange.
@RheumNow https://t.co/io8OGnWxdS
Dr. Rachel Tate uptoTate ( View Tweet)
Is there data for PLEX in GPA?
@anisha_dua #RNL2024 @RheumNow
PEXIVAS negative study
But subgroups show decreased dialysis...
But, no improvement in mortality and increased infection risk https://t.co/K9VbcNNsge
Eric Dein ericdeinmd ( View Tweet)
#RNL2024 @RheumNow
@anisha_dua
Throwing the kitchen sink in severe GPA
CYC + RTX combo - sick population (median GFR 9, 47% on HD, 52% DAH, all received PLEX too)
- 85% survival, 69% not ESKD, low rates of relapse (13% at 36 mos)
But, prolonged B cell depletion, aggressive Rx https://t.co/9AZFMQ3o9P
Eric Dein ericdeinmd ( View Tweet)
#RNL2024 is up and at ‘em this Sunday morning! @RheumNow @KDAO2011 @RichardPAConway @ericdeinmd https://t.co/AtL9QiRnW4
Dr. Rachel Tate uptoTate ( View Tweet)
@anisha_dua reviews differences between EULAR vs ACR Vasculitis guidelines #RNL2024 @RheumNow https://t.co/1aIbnX5KBI
TheDaoIndex KDAO2011 ( View Tweet)
@anisha_dua reviews GPA management in 2024. Here are your ACR/VF 2021 and EULAR 2022 guideline updates. Review these regimen options for your patients. #RNL2024 @RheumNow https://t.co/SvQoe0YKKV
Dr. Rachel Tate uptoTate ( View Tweet)
Nipple Raynaud's is an issue for some women with rheumatic diseases that occurs during breastfeeding and can be very painful @DrCassySims #RNL2024 @rheumnow
https://t.co/HbaRpUnEBF
TheDaoIndex KDAO2011 ( View Tweet)
High risk medications for pregnancy:
MTX- 40% pregnancy loss, 6-10% birth defects
MMF/CYC - 40% pregnancy loss, 25% birth defects
Recommend 2 forms contraception on MMF
Change meds slowly to safe Rx and monitor disease activity at least 3 mos before pregnancy
#RNL2024 @RheumNow
Eric Dein ericdeinmd ( View Tweet)
@DrCassySims noted if pts get accidentally pregnant on Methotrexate, stop med and give high dose folic acid 5 mg/d and alert high risk OB/MFM #RNL2024 @RheumNow #ReproductiveRheum https://t.co/DFiwaTiHVf
TheDaoIndex KDAO2011 ( View Tweet)
Clinical Pearl!
@DrCassySims currently treats with ASA 81mg po daily during vasculitis pregnancies at 12 weeks for preeclampsia ppx.
She notes there is some data/use of 162mg po daily in Europe which may change the way we practice in the future.
#RNL2024 @RheumNow
Dr. Rachel Tate uptoTate ( View Tweet)
"Please remember to discuss personal goals with patients (such as having children) centered around options that would not risk personal health (disease worsening, flaring, death, etc), such as surrogacy in pregnancy." @DrCassySims @RheumNow #RNL2024
Dr. Rachel Tate uptoTate ( View Tweet)