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Dual inhibition of IL17A and IL17F in AxSpA
A new target for treatment in AxSpA is the dual inhibition of IL17A and IL17F (IL17A/F). IL17A is a key driver of the inflammation in the AxSpA and Psoriatic Arthritis (PsA). IL17A and its structurally related IL17F share biologic functional properties. Inhibition of both cytokines (IL17A/F) should result in a greater clinical benefit in AxSpA and PsA than IL17A inhibition alone.
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Practical use of JAK inhibitors in select groups in Axial SpA
A new treatment for AxSpA that has come on the scene are JAK inhibitors. In clinic, considerations for JAKi use are body mass index, smoking status, prior use of biologics and patients with high inflammatory states such as high CRP and inflammatory change on MRI scan of the spine and sacroiliac joints. There are further studies at #ACR22 which help answer these questions.
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BE OPTIMAL Study - Bimekizumab (IL-17A and IL-17F inhibitor) for treatment of PsA.
Similar ACR 50 (~50%) response rates of Bimekizumab, adalimumab, and placebo (switched to BKZ at wk 16).
~60% PASI100 in BKZ
#ACRBest Abs#L02 @RheumNow #ACR22 https://t.co/W2B2kyju9F
Robert B Chao, MD doctorRBC ( View Tweet)
Ritchlin et al. Bimekizumab in bDMARD naive PsA. 52 week results. Not surprisingly, week 16 outcomes sustained. No joint difference to ADA, skin slightly better @RheumNow #ACR22 Abstr#L02 https://t.co/RjCV8Hb3HR https://t.co/a0NQFyFZlt
Richard Conway RichardPAConway ( View Tweet)
#L02 #acr22 @rheumnow Bimekizumab ph3 in PsA: meaningful clinical improvement, improved mTSS, no new safety signals. Wk 52 ACR50: 53.0% PBO/BKZ, 54.5% BKZ, 50.0% ADA; MDA 53.7% PBO/BKZ, 55.0% BKZ, 52.9% ADA . mTSS change from baseline ≤0.5): 87.3% PBO/BKZ, 89.3% BKZ, 94.1% ADA https://t.co/NYRrPUBjt1
Olga Petryna DrPetryna ( View Tweet)
Get the skinny on Bimmy! Gotta learn this name #Bimekizumab in bio naive PsA N=852 Bimmy=IL17 A & F inhibitor Great data on skin & joints. Where will it fit in as we have other IL17Ai’s is IL17F giving added value? #ACR22 #ACRBest @RheumNow https://t.co/wNAzTaLhsM
Janet Pope Janetbirdope ( View Tweet)
L14 #ACR22 Bimekizumab BE MOBILE 1 and 2
Sustained efficacy to Wk52. ASAS40 in BKZ incr from W16 (47% nrAxSpA, 45% AS) to W52 (61%, 58%). Efficacy in TNF-naive & TNF-failure.
AEs: Nasopharyngitis (12% nrAxSpA, 9% AS), URI (9, 6%), candidiasis (7, 6%), COVID (7, 2%)
@RheumNow https://t.co/G31PrfqtVu
Eric Dein ericdeinmd ( View Tweet)
Bimekizumab (BKZ) in AxSpA to Wk52
◦ sustained efficacy
◦ suppression of inflammation
◦ improvements in function and quality of life
◦ no new safety signals were observed
◦ consistent with the safety profileWk24 data
Baraliakos #L14 https://t.co/gk23g4vqQl #ACR22 @RheumNow
Dr. Antoni Chan synovialjoints ( View Tweet)
Kiltz et al. Greater efficacy of secukinumab in normal BMI than high BMI AS patients. Decremental effect with increasing BMI. @RheumNow #ACR22 Abstr#1495 https://t.co/zwEmQsJmPT https://t.co/nOW2IbTc5t
Richard Conway RichardPAConway ( View Tweet)
Benesova et al. Higher treatment response to secukinumab in both male and female AS patients when diagnosed earlier. No such effect seen in PsA patients. Emphasises need to reduce diagnostic delay in AS. @RheumNow #ACR22 Abstr#1497 https://t.co/9g2zN85a33 https://t.co/LfvQFTKr69
Richard Conway RichardPAConway ( View Tweet)
BE COMPLETE study:
Bimekizumab (IL-17A and IL-17F inhibitor) efficacious in phase 3 trial for treatment of PsA. No new safety signals.
Abs#1599 @RheumNow #ACR22 https://t.co/iXj7wSRNeK
Robert B Chao, MD doctorRBC ( View Tweet)
Does Bimekizumab, anti-IL17F, work in PsA? #ACR22 @RheumNow
Abstract #L02
💊Phase 3, randomized, placebo-controlled study
💉Biologic naive patients
✋ Week 52: 53-54% BKZ groups achieved ACR502 (v. 50% in TNFi)
📍benefits sustained to week 52
🛑No new safety signals
Catherine Sims, MD DrCassySims ( View Tweet)
axPsA and AS adult pts exhibit different genetic risk factors & serum IL-17 levels. GUS demonstrated significant pharmacodynamic effects and clinical improvement in axPsA and non-axPsA pts. Abs 1038 #ACR22 @RheumNow https://t.co/9Rjw7usO8J
Dr. Rachel Tate uptoTate ( View Tweet)
Deodhar et al. Bimekizumab (IL-17A/Fi) in nr-axSpA. Efficacy shown across all outcomes. Confirms bimekizumab works across spectrum of axSpA (not surprisingly). @RheumNow #ACR22 Abstr#0544 https://t.co/XVGBgBQpTH https://t.co/39zW5Ex9xh
Richard Conway RichardPAConway ( View Tweet)
IL17A/Fi BImekizumab BKZ to Wk 24 achieved reduction in
◦ total spinal pain (SP)
◦ nocturnal SP
◦ morning stiffness (BASDAI)
◦ fatigue (FACIT-F)
Deodhar et al, BE MOBILE 1,2 Abst 0409 https://t.co/vpCrG2COuB
#ACR22 @RheumNow
Dr. Antoni Chan synovialjoints ( View Tweet)
IL-17A/F inhibition with Bimekizumab in active nr-axSpA Wk 16 ASAS40 vs PBO
• Rapid improvement 47.7 vs 21.4%
• TNF naive 46.6 vs 22.9%
• TNFIR 60 vs 11.8%
• Wk 24 >50% ASDAS <2.1
• Improved MRI
• Serious TEAE 0.4%
Deodhar Abs0544 https://t.co/q9dbQP5oLD #ACR22 @RheumNow https://t.co/VCJgo56JrA
Dr. Antoni Chan synovialjoints ( View Tweet)
What’s new to treat PsA? Let’s discuss anti-IL-17A, Izokibep #ACR22 @RheumNow
Abstract #0199
💪 Izokibep 40 v. 80 mg q2 weeks SQ v. placebo
💪 135 patients, 28 sites
💪 At 12 weeks, all patient reported outcomes and PsAID subdomains significantly improved (dose dependent)
Catherine Sims, MD DrCassySims ( View Tweet)
2022 ASAS-EULAR Recommendations of AxSpA management
1) NSAIDs still first line
2) Analgesics/opioids contraindicated
3) TNFi, IL-17i first line bDMARDs, followed by JAKinibs
4) Tapering but not discontinuation of bDMARDs in sustained remission
Abs#0542 @RheumNow #ACR22 https://t.co/ffaN2fMc3v
Robert B Chao, MD doctorRBC ( View Tweet)
The new IL-17A/F inhibitor, bimekizumab, was comparable to current established therapies in active #AnkylosingSpondylitis. Check our NMA poster today. #ACR22 #SpA #medtwitter @TheBold_MD @cplch19 @UTSWRheum @ACRheum @RheumNow @DrCassySims https://t.co/vxa05r0GvS
Adela Castro AdelaCastro222 ( View Tweet)
Withdrawing IL17i will more likely cause a relapse, but pts will respond when reintroduced -Dr Scher #PsA @rheumnow #acr22 #acrreview https://t.co/FvWVuQGJda
TheDaoIndex KDAO2011 ( View Tweet)
