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ACR 2025 – Day 2 Report

Jack Cush, MD

Here are 3 abstracts that caught my eye on Day 2 at ACR25. Notably these have takeaway messages that should support your current practices.

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#1723 Why is systemic autoimmunity more common in females? Loss of X-chromosome inactivation maintenance in B cells (not T cells) amplifies interferon-driven disease, with increased autoantibodies, inflammation and renal injury. Key mechanistic advance. @RheumNow #ACR25

Mrinalini Dey DrMiniDey ( View Tweet)

3rd plenary session! #1722 Defining safe HCQ levels in SLE: whole-blood 750-1150ng/mL= therapeutic range; >1150ng/mL ➡️ ~2× toxicity risk; <750ng/mL ➡️ higher flare risk CKD ≥3 increases odds of supratherapeutic levels New era of precision monitoring in SLE? @RheumNow #ACR25

Mrinalini Dey DrMiniDey ( View Tweet)

Plenary 3, HCQ blood levels in SLE HCQ level > 1150: 1.9x risk of HCQ toxicity HCQ level < 750: 1.4x risk of active SLE HCQ dose < 5mg/kg: 1.9x risk active SLE My take home? Blindly reducing dose to <5mg/kg is BAD; use levels instead! @RheumNow #ACRBest #ACR25 Abstr1722 https://t.co/UCBPAKAyon

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Mike Putman EBRheum ( View Tweet)
#ACR25 Please find my video interview with Dr Kate Rochlin on a novel Bi-specific T-cell engager (BiTE) in development which binds to pan-gamma delta T-cell instead of CD3 to minimise risk of cytokine release syndrome side effect. Abstr#1535 @RheumNow https://t.co/MOmUm41cyA https://t.co/TgIUGgWGw5

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Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
PET and histologic discordance in aortitis Of 5 aortitis patients who had PET/CT prior to aortic surgery with path, only 1 showed concordance (neg PET, neg biopsy) 4/5 patients had inflammatory biopsy with neg PET Small # but PET is not perfect! @RheumNow #ACR25 Abst 1620

Brian Jaros, MD Dr_Brian_MD ( View Tweet)

Abstract 1718: Immune checkpoint inhibitors (ICI) in pre-existing #SLE Compared to non-SLE pts, those with SLE receiving ICIs had: 🔹 ↑ risk of thrombocytopenia & pancytopenia 🔹 No significant difference in all-cause mortality @RheumNow #ACR25 https://t.co/N1iOvxbsAZ

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Akhil Sood MD, MS AkhilSoodMD ( View Tweet)
IL-5 agents may in fact work for severe EGPA manifestations Although severe pt were excluded from enrollment in MANDARA, post-hoc and OLE data suggest development of severe manifestations is rare in benra treated patients @RheumNow #ACR25 https://t.co/slUpAT9mWo

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Brian Jaros, MD Dr_Brian_MD ( View Tweet)
ANCA status does not inform IL-5 agent response in EGPA patients Terrier et al. analyzed the OLE of MANDARA and compared ANCA+ and ANCA- subgroups: - similar rates of remission - similar rates of GC withdrawal - comparable relapse rates @RheumNow #ACR25 Abst 1594

Brian Jaros, MD Dr_Brian_MD ( View Tweet)

Abstract 1657: Can LLMs track medication history? GPT-4 outperformed most LLMs in identifying TNFi start/stop events and reasons for switch. 💊 Common reasons for TNFi switching: lack of effectiveness, adverse events, and insurance/cost barriers. @RheumNow #ACR25 https://t.co/5FUR9tBoyu

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Akhil Sood MD, MS AkhilSoodMD ( View Tweet)

#ACR25 Abstr#1532 “The more the merrier” or “Too many cooks..” Preliminary data of CTA313, dual CD19-BCMA CAR-T in 15 #SLE pts showed deep depletion & good response. Global study is planned. Will have to keep on eye on safety (G3 herpes zoster, pneumonia & neutropenia) @RheumNow https://t.co/0KQa9K6bYB

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Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
#ACR25 Abstr#1608 10! 10! Across the board. 2-yr data from RCT + Open Label showed frequency of both airway and non-airway features of #EGPA improved with Benralizumab/Mepolizumab. Provides assurance to use more in real-world @RheumNow https://t.co/i78xXojGja

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Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)

#ACR25 Abstr#1537 Beyond T-cell malignancy, we should be vigilant re: Local immune effector cell-associated toxicity syndrome (LICATS) with CAR-T. - Mostly afect skin & kidneys - Med time of onset 10 days; duration 11 days -Most LICATS were mild & without sequelae @RheumNow https://t.co/EnAWL936oh

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Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
So who with inflamm arthralgias might benefit from abatacept, in terms of delaying RA onset? ALTO study (APIPPRA continuation) 1y abatacept then follow If autoAb x5 (RF, ACPA IgG, IgA, anti-CarP, AAPA): sustained delay of RA If not: benefit only on Rx #ACR25 ABST1678 @RheumNow https://t.co/3Pc5ZLzVf6

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David Liew drdavidliew ( View Tweet)
Early TNFi treatment leads to -Less D2T at 5 yrs -More sustained remission at 10yrs -Less bDMARD escalation at 5yrs -More DMARD free remission at 5yrs and 10 yrs -20% reduction annual healths costs -11 mo delay in ttmt escalation Safety data were not presented #ACR25 https://t.co/jPMGUGPtqP

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Aurelie Najm AurelieRheumo ( View Tweet)
SELECT-COMPARE RA UPA vs. ADA What do we learn from 7 years data? Not much Patients who did well on the first drug, keep doing well Patients who required switching for primary failure don't do as well, w/ 26% pts reaching DAS remission in UPA + MTX vs. 16% in ADA + MTX gp No https://t.co/JLUTRZuZOm

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Aurelie Najm AurelieRheumo ( View Tweet)
In case you missed it in @ACR_Journals: HCQ for 1y does not prevent RA development in people with CCP3 >2x ULN, either: - during 1y of treatment - in 2y follow-up https://t.co/gtzNiSmutb but StopRA will give us plenty of insights - data is never wasted #ACR25 ABST1674 @RheumNow https://t.co/DDZib5VGtX

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David Liew drdavidliew ( View Tweet)
SELECT-COMPARE (upadacitinib vs adallimumab in mod-severe RA, no CV enrichment) 7y data: safety profiles very similar, except for: - zoster - CK rise - lymphopenia - hepatic disorder In the general RA population, no new JAKi safety signals #ACR25 ABST1676 @RheumNow https://t.co/BA2JxONGfa

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David Liew drdavidliew ( View Tweet)
Start strong, stay strong. With early anti-TNF induction (vs csDMARD T2T) - At 5 yrs: D2T RA in <1% vs 7% (OR 0.11, p=0.03) Drug-free remission 13% vs 6% (p=0.049) - At 10 yrs: more sustained remission (62% vs 45%) & fewer multi-MoA failures. @RheumNow #ACR25 Abstract #1677

Jiha Lee JihaRheum ( View Tweet)

What is the secret of a VNS RCT that works in RA? => Implant the device! RESET-RA RCT Sham controlled 3mo Then open label in active arm for 66mo 40% pts IR to >=3 bioDMARDs ACR 20 3 mo 42% vs. 19% CDAI LDA 27% vs. 11% 82% TNF IR pt had no change in treatment over 12mo 99% https://t.co/lfxa4YXUB4

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Aurelie Najm AurelieRheumo ( View Tweet)
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