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The Influence of Obesity on Choice of Biologic Agent in Rheumatoid Arthritis
In rheumatoid arthritis we have a wide range of options available to us when we progress to a biologic treatment option. We have little to differentiate between these agents based on the clinical trials.
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MUC5B and RA-ILD. Dr McDermott @jeffsparks show that MUC5B is associated with RA-ILD, older age at RA diagnosis, and ILD within 5 years of RA onset. Is this a different disease to other RA or modulation by the promotor variant? Abstr#0576 #ACR21 @RheumNow https://t.co/r2fQqxVY6N
Richard Conway RichardPAConway ( View Tweet)
And here is ORAL-Surveillance, small increase in MACE and malignancy with tofacitinib vs TNFi. 1 extra MACE per 319-567 patient years, 1 extra malignancy per 275 patient years. Abstr#0831 #ACR21 @RheumNow https://t.co/wMJnspTTBy
Richard Conway RichardPAConway ( 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)
Dr. Thomas reviews risk for progression to RA
👉+ACPA (9% risk)
👉1st degree relative 3-9X risk
👉70% risk in 5 years of both are true!👈
#ACR21 @rheumnow https://t.co/y5eUyacBFT
TheDaoIndex KDAO2011 ( View Tweet)
An important message from Dr Ranjeny Thomas on #RA #disease control: "Patients can have a significant impact on the control of their disease, and the interventions we recommend need to be personalised to their resilience ability." #ACR21 @RheumNow https://t.co/h63uz5kfU8
Aurelie Najm AurelieRheumo ( View Tweet)
Booking regular clinic visits for controlled RA pts - can we be more efficient?
12m RCT
Self-monitoring app, supported self-initiated care
only one scheduled follow-up visit
controlled RA pts
DAS28/pt satisfaction same
visits/y: 1.7 vs 3.0
@reade_020 #ACR21 ABST0830 @RheumNow https://t.co/600XTKo9GM
David Liew drdavidliew ( View Tweet)
Risks for RA:
- chromosome 6 has HLA risk genes encoding HLA-I and -II
- HLA-DRB1 *04:01 and *04:04 stonrgly assc w/ RA in white Americans/Europeans
- the Shared epitope increase risk for RA & severe disease; high assc with ACPA+
Protective➡️HLA-DRB1*13:01 @rheumnow #ACR21 2/2
TheDaoIndex KDAO2011 ( View Tweet)
Chances for RA if a family member has RA?
Dr. B Masri reviews familial studies:
👉person w/1st degree relative w/ RA has 2-4 X risk
👉Multigen study standard incidence ratios: 3.02 child, 4.64 siblings, 9.31 in multiplex family, 6.48 twins, 1.17 in spouses #ACR21 @rheumnow 1/
TheDaoIndex KDAO2011 ( View Tweet)
Dr. Ranjeny Thomas on preventing RA:
👉60% genetics/immunopathogenesis (noncontrollable factors)
👉40% lifestyle modifications: healthy diet, healthy weight, avoiding tobacco, reduce occupational exposure, improve exercise/sleep, decrease stress.
#ACR21 @rheumnow 1/2 https://t.co/eoh3kcekR8
TheDaoIndex KDAO2011 ( View Tweet)
Dr. R Thomas: current studies on prevention of RA:
👉oral DMARDS (MTX, HCQ)
👉biologics (RTX, abatacept)
👉 studies regulating T cells to restore tolerance
👉biomarkers of tolerant state & look at people who don't develop RA
👉 imaging as window of subclin dz. #ACR21 @rheumnow https://t.co/5bsu5459az
TheDaoIndex KDAO2011 ( View Tweet)
#ACR21 Abs#0818: Starting biologics in moderate vs severe RA activity:
▶️ Moderate disease activity: more likely to reach LDA, remission
▶️ Severe disease: greater overall improvements, but less likely to reach remission
https://t.co/9jBtN9wUGF @Rheumnow
Links:
Eric Dein ericdeinmd ( View Tweet)
So it's day 2 at #ACR21, and you know what that means - it's ORAL Surveillance day!
This is the figure everyone will be talking about, leading up to details in the plenary.
Why are the other bars higher than the pink bars?
ABST0831
plenty of @RheumNow coverage coming on this https://t.co/B80cSmhNV7
David Liew drdavidliew ( View Tweet)
Abst#0788 #ACR21. Forgot to measure vitamin D?
▶️ Red cell distribution width (RDW) inversely correlates w vit D 25(OH) levels prior to MTX
⭐️ RDW ⬆️ after starting MTX, no longer correlates
https://t.co/b5EPDmGE18 @Rheumnow https://t.co/cNN14ErOmF
Links:
Eric Dein ericdeinmd ( View Tweet)
ORAL Surveillance
In mod-severe RA pts >50yo, with CV RF & no hx malignancy, patient-years of exposure required for one event (vs TNFi):
MACE
tofa 5mg bid: 567
tofa 10mg bid: 319
malignancy
tofa 5mg bid: 276
tofa 10mg bid: 275
#ACR21 ABST0831 @RheumNow https://t.co/9vyXPTMFzj
David Liew drdavidliew ( View Tweet)
#ACR21 Abst#0793. Japanese multicenter US cohort (KUDOS) study, looked at difficult to treat (D2T) RA pts
▶️ 1/5 pts are D2T (fail 2+ b/tsDMARD, mod disease or GCs)
⭐️ Contributors of good outcomes: IL-6i (OR 9.6), concomitant MTX (OR 7.1)
@Rheumnow https://t.co/9YSa4ebQlR
Links:
Eric Dein ericdeinmd ( View Tweet)
Greater #comorbidity burden is assoc. w/ worse improvement and disease activity in 1st yr of treatment in ERA @earlyarthritis.
Comorbidities esp affect SJC and patient and physician global assessments.
#ACR21 Abs#0798 @RheumNow
https://t.co/02BRqYp9Yk
Mrinalini Dey DrMiniDey ( View Tweet)
#ACR21 Abst#0801 Early remission at 6 mos is a predictor of long-term remission in patients w new onset RA
▶️ DAS28-CRP, SDAI, CDAI at 6mo predicted remission at 60 months
https://t.co/vWy7EmseZp @Rheumnow https://t.co/HWJSjvFY8d
Links:
Eric Dein ericdeinmd ( View Tweet)
How can we better identify patients with #RA-ILD using #EHRs?
Abs#0561: previously validated algorithms have clinical & research utility when applied to EHRs, esp when well-integrated with key info such as CT chest reports
#ACR21 @RheumNow
https://t.co/OU8BdwqHpc
Mrinalini Dey DrMiniDey ( View Tweet)
ADACTA & MONARCH both showed IL6i monoRx > TNFi monoRx for RA in DBRCTs.
What about in real-world data?
Looking at CorEvitas, less so
LDA: aOR 0.99
MCID in CDAI: 1.06
Even without MTX, both great drug classes for RA
Equally so?
#ACR21 ABST0834 @RheumNow https://t.co/6wvzVrXTW6 https://t.co/fYEktJhZuV
David Liew drdavidliew ( View Tweet)
