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RIP to Glucocorticoids in GPA

d Richard Conway, MBBChBAO, PhD

For many years glucocorticoids were the mainstay of our treatment of granulomatosis with polyangiitis (GPA). The paradigm shifted with cyclophosphamide and then again with rituximab, and we used less steroids, but we still used lots. Avacopan teased the demise of steroids, but in the trial they, and now we, still use them. Glucocorticoids are our old trusty friend, our comfort blanket. But no more! Good riddance to the medication with the highest long-term adverse event burden that we use. Long-term glucocorticoids in GPA should now be a rarity. The reason for such exuberance is the TAPIR study presented by Dr. Peter Merkel at Saturday’s opening plenary session.

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TAPIR study of continuing vs stopping steroids in ANCA vasculitis in remission. Relapse at month 6 in 16% vs 4%. OR 4.22, but low rate in either group. If treated Rituximab, no difference! Merkel et al. @RheumNow #ACR24 Abstr#0774 #ACRbest https://t.co/pKa4U5L2fW https://t.co/MjzE14SeGi

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Richard Conway RichardPAConway ( View Tweet)

TAPIR study of continuing vs stopping steroids in ANCA vasculitis in remission. Relapse at month 6 in 16% vs 4%. OR 4.22, but low rate in either group. If treated Rituximab, no difference! Merkel et al. @RheumNow #ACR24 Abstr#0774 #ACRbest https://t.co/pKa4U5L2fW https://t.co/MjzE14SeGi

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Richard Conway RichardPAConway ( View Tweet)
"If you want an argument, put two rheumatologists in a room and ask them about steroid tapers. Add a third and you'll have a fight" -P. Merkel at UPA plenary session #ACR24 @RheumNow

Mike Putman EBRheum ( View Tweet)

Results from SELECT-GCA ➡️UPA 15mg + 26W GC taper demonstrates superior efficacy & reduced GC use vs PBO + 52W GC taper ➡️No new safety signals Is UPA the new kid on the block in #GCA? Ab0770 #ACRBest #ACR24 @RheumNow https://t.co/pHzozYiid5

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Mrinalini Dey DrMiniDey ( View Tweet)
The TAPIR Trial on GPA shows higher (15.5%) relapse in the 0 mg prednisone arm vs. 4.2% in the 5 mg arm (OR 4.22), but does not impact PROs. Key finding: benefit of 5 mg/day seen only in non-rituximab regimens (20% vs. 2.6%, OR 9.50). Abstr#0774 Plenary 1 @RheumNow #ACR24… https://t.co/5DjW5Zwh0J https://t.co/UnsVPzJfs6

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Antoni Chan MD (Prof) synovialjoints ( View Tweet)
The TAPIR Trial on GPA shows higher (15.5%) relapse in the 0 mg prednisone arm vs. 4.2% in the 5 mg arm (OR 4.22), but does not impact PROs. Key finding: benefit of 5 mg/day seen only in non-rituximab regimens (20% vs. 2.6%, OR 9.50). Abstr#0774 Plenary 1 @RheumNow #ACR24… https://t.co/5DjW5Zwh0J https://t.co/UnsVPzJfs6

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Antoni Chan MD (Prof) synovialjoints ( View Tweet)

SELECT-GCA: Upa in GCA Merkel Upa 15 mg v 7.5 v PBO w slower GC taper 70% new onset, 30% relapse. Few prev on IL6 Primary endpt: sustained remission at w52- UPA 15 mg beats PBO (p=0.0019) 34% relapse in UPA vs 60% PBO Less steroids, longer time to flare @RheumNow #ACR24 #ACRBest https://t.co/1OV2889Ny0

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Eric Dein ericdeinmd ( View Tweet)
Abatacept for GPA? Tx with Abacept did NOT significantly reduce rates of treatment failure compared to GC + PBO (background DMARD allowed) in non-severe, relapsing GPA Continued need for tx options in non-severe relapsing dz @RheumNow #ACR24 Abstract #0823 https://t.co/7GfprUzoL7

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Brian Jaros, MD Dr_Brian_MD ( View Tweet)
Kawasaki.jpg

Diagnosis and Management of Kawasaki Disease

d EurekAlert!

The journal Circulation has published a comprehensive overview called “Update on Diagnosis and Management of Kawasaki Disease,” summarizing data published since the 2017 American Heart Association Scientific Statement on Kawasaki Disease related to diagnostic criteria, risk scores and treatment options for children and adults with this condition.

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Dr. Quotes (11.8.2024)

d Jack Cush, MD

Dr. Jack Cush reviews the news and journal reports from this past week from RheumNow.com.

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Literature review of the treatment of IgA Vasculitis (Henoch–Schönlein Purpura) suggests: - Glucocorticoids are 1st -line therapy, esp if severe - For minor HSP: colchicine, dapsone, & methotrexate may be useful - Also studied cyclosporine A, tacrolimus, MMF… https://t.co/ZoZX3kyHvo https://t.co/dS82ekuEkv
Dr. John Cush RheumNow ( View Tweet)
Susac syndrome is a rare disease of young women characterised by microvessel occlusive Dz limited to the brain, retina, and inner ear. Rx is steroids, but Lancet Rheumatol Review of Rx shows no benefit of immunosuppressive Rx https://t.co/FvJa9OZLWL https://t.co/NVS0I3ofm8

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Dr. John Cush RheumNow ( View Tweet)
How would you treat an anti-synthetase overlap pt w/ myositis, polysynovitis & rapid ILD (pt on steroids)?

Dr. John Cush RheumNow ( View Tweet)

STAR study shows 102 RA pts in LDA > 3 mos & pred 5 mg/d did equally well with either prednisone taper or changing to hydrocortisone 20 mg/d and taperin HC. At 12 mos both wer able to D/C GC (55% HC vs 47% pred tapering; p=0.4). https://t.co/C6YTGiF0pN

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Dr. John Cush RheumNow ( View Tweet)

SPRINGBOARD: Extended-release Intra-articular Corticosteroid Injection in Knee OA A phase 2 trial of EP-104IAR (long-acting, fluticasone propionate) has shown 14 weeks of clinically meaningful pain relief in knee osteoarthritis (OA). This intra-articular formulation is… https://t.co/IjlEDMmzzH https://t.co/Ly40yQgZ8e
Dr. John Cush RheumNow ( View Tweet)
Ganglion cysts are thin walled cavities contain a viscous, mucinous fluid, arising in proximity to joint capsules/tendon sheaths but do not communicate with the joint. Most common w/ repetitive strain or overuse, trauma, or inflam. arthritis. Steroid injx dont… https://t.co/nUlQvemYa5 https://t.co/gSNzBuPeW4
Dr. John Cush RheumNow ( View Tweet)
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Blue Collar Arthritis (10.25.2024)

d Jack Cush, MD

Dr. Jack Cush reviews the news and journal articles from this past week on RheumNow.com.

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2 yr results from the PRAIRI study - 78 at-risk (for RA) pts Rx w/ placebo or 1000 mg IV RTX + I00 mg methylprednisolone (MP). While 1 yr result showed brief delay in RA development, at 2 yrs there was no benefit for QOL or RA development https://t.co/1CzEQn5zL4 https://t.co/Wvr2kWvDC5

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Dr. John Cush RheumNow ( View Tweet)
Retrospective study compared IV methylprednisolone (IVMP) to oral glucocorticoids (GC) Rx in 419 #GCA pts (>90% vision Sx). 26% Rx w/ IVMP was not superior at survival or visual ac uity than GC, but IVMP was assoc w/ signif more diabetes @1 yr (OR 2.59) https://t.co/pRBA18Fzyw https://t.co/z6Sw5LTtGq

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Dr. John Cush RheumNow ( View Tweet)

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