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ACR23 – Day 1 Report
ACR 2023 is back in San Diego for its annual convergence of thousands of rheumatologists to partake, discover and learn from thousands of abstracts and hundreds of sessions and presentations. It was a big return for the Poster Hall with rows and rows of research, friends, fellows and poster tours. Below are a few of my favorite presentations from the posters, Plenary and oral sessions on day one.
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#GCA Rx #bDMARD is established to #steroid spare and reduce relapses. #Tocilizumab #GiACTA Dr Seo said ‘biologics work and steroids are bad!’ @ACRheum @RheumNow #ACR23 #ACRbest https://t.co/JmSE1KKlf5
Janet Pope ( View Tweet)
The Great Debate #ACR23 - and it’s a cracker.
Is early steroid-sparing therapy justified in GCA/PMR? I don’t know, but Rob Spiera and @philseo will battle it out to tell us.
(and ably moderated by the always eloquent @SattuiSEMD)
I’ll put some highlights here ⬇️🧵
@RheumNow https://t.co/ASpuglyENv
David Liew drdavidliew ( View Tweet)
Baseline vascular ultrasound predicts clinical outcomes @ 3 months. Subclinical GCA = relapse 37% vs 15%. Higher cumulative steroid dose. @sharoncowley01 @DrTrishHarkins Abstr#1565 #ACR23 @RheumNow https://t.co/b35CkFS0lz https://t.co/suBGR1ByDK
Richard Conway ( View Tweet)
So firstly the no case, and Rob Spiera takes up the case, dictated by the electronic coin toss.
No-one disagrees that we need steroid-sparing options, or that IL-6Ri work in PMR and GCA. But it’s the strategy questions which remain in play:
#ACR23 @RheumNow https://t.co/I2QDU7l6DE
David Liew drdavidliew ( View Tweet)
Real World SLE Rx patterns from the SPOCS cohort. 70+% IFN high, 81% on antimalarials, 21% biologics, and 55% IS, 65% GCs. High IFN pts had more IS and steroid use. 45+% still on GCs at 12 months despite avail of new therapeutics @RheumNow #ACR23 abst#0592
TheDaoIndex KDAO2011 ( View Tweet)
Sunday recap @RheumNow
Very interesting abstracts:
https://t.co/BX8bDSX1M3
1- Fecal calprotectin in SpA population.
2-SLE; high or low steroids? Rapid or slow taper?
3-Molecular biomarkers for PAH in SLE.
4-Repeating imaging in ? Chronic back pain?
And others …….
Nouf Al hemmadi ( View Tweet)
#ACR23 Abstr#0784 Beyond renal response, let’s also focus on kidney function and Steroid-sparing effect. Post-hoc analysis of Phase 2 RCT showed Obinutuzumab preserved eGFR by 4ml/min/1.73m2/year with greater number of pts achieving <7.5mg/d of prednisolone bs PBO @RheumNowNews https://t.co/2hW74UF1ta
Md Yuzaiful Md Yusof ( View Tweet)
20 years real-world data on disease burden, patient experience & unmet needs in Refractory #RheumatoidArthritis
▶️Higher glucocorticoid & opioid use
▶️Greater comorbidity & symptom burden
▶️More rheumatology visits
#ACR23
👉🏽https://t.co/CAUorjQbvN
by @KristinWipfler @Dr_K et al https://t.co/vx1aOZizfE
Dr Ai Lyn Tan DrAiLynTan ( View Tweet)
#ACR23
Scleroderma renal Crisis (SRC)
May precede skin involvement also.
RISK FACTORS
• Early diffuse skin disease
- 2-3 years from SSc onset, median 8 months
• Anti-RNA polymerase III (60%)
• Use of corticosteroids
- >15 mg/d or low doses for longer time https://t.co/RSIxEXLdX7
Aditya Burje AdityaBurje ( View Tweet)
Are we tapering steroids too rapidly? Real world experience: steroid tapering in severe #AAV based on #PEXIVAS protocol noted higher rates of dz progression, relapse, ESRD, death. Risk greatest when creatinine > 300umol/L and w/RTX induction #Plenary1 #ACR23 Abst#0725 #ACrBest https://t.co/Rtv7vkzUUD
TheDaoIndex KDAO2011 ( View Tweet)
Reduced-dose GC regimen in severe GPA or MPS (creatinine >300 umol/L, RTX as induction) associated with increased risk of death, ESKD, progression before remission requiring treatment modification or relapse, Nagle S Abst#0725 #ACR23 #ACRBest @RheumNow https://t.co/ZVZYRnSy3n
Dr. Antoni Chan ( View Tweet)
#ACR23 Abstr#0782 Triple therapy in #lupus nephritis. Propensity match data AURORA vs ALMS showed pts treated with voclosporin+MMF+low dose GC vs MMF+High dose GC achieved earlier reduction in UPCR & fewer AEs. Cdnt control for everything e.g. HCQ but assuring @RheumNow #ACRBest https://t.co/dmriAyQPr0
Md Yuzaiful Md Yusof ( View Tweet)
Differences in #glucocorticoid dosing. In #lupus #nephritis less steroids are the same as high dose steroids. Placebo arms of pooled data from #LN #RCTs. Less is equal! #ACRbest #ACR2023 @RheumNow @ACRheum abst0781 High dose steroids tended to have lower MMF doses https://t.co/XwTlsy4xKE
Janet Pope ( View Tweet)
Sarilumab for relapsing of PMR. Any thing to to taper off prednisone quickly.
#ACR23 , year in review.
Lost of good studies and smart discussions @RheumNow at Make rheum for PMR month. https://t.co/VyRP8ls3OC
Nouf Al hemmadi ( View Tweet)
Important plenary re:reduced vs standard GC for AAV... IRL
PEXIVAS & recent guidelines supported low dose taper
Real world data w/severe dx? Increased risk of death & ESKD for REDUCED pts
Need full data but yikes...
@RheumNow #ACR23 #ACRBest https://t.co/3S23O9d1ok
Mike Putman EBRheum ( View Tweet)
Abst#0725 #ACR23 @RheumNow
PEXIVAS Real life data!
GPA & MPA pts - Retrosp observ study
⭐️Reduced-dose GC regimen ass w/ INCREASED risk of death, ESKD, progression
Greatest risk: pt w Cr levels >300 umol/L, RTX induction Rx
⚠️Caution w/ reduced GC, RTX, severe kidney dis
#ACRBest https://t.co/7qI5c1ZiqO
Eric Dein ( View Tweet)
Interesting study on PEXIVAS reduced steroid use from today's plenary session!
Reduced steroid dose in GPA/MPA pts associated w/
INCREASED risk of death, ESKD, progression of dz
Even greater risk in pts with higher Cr lvls or RTX induction use
@RheumNow #ACR23 Abs#0725 #ACRbest https://t.co/frsOrANKhf
Robert B Chao, MD ( View Tweet)
Real world data on low dose PEXIVAS steroid by Nagle et al. Increased risk of progression/relapse/death/ESKD in those with severe GPA/MPA HR 1.72. More marked in those with creat>300 or with RTX induction Abstr#0725 #ACR23 @RheumNow https://t.co/vTXVZfjbXx https://t.co/4FuMjxOuyB
Richard Conway ( View Tweet)
#ACR23 Real-world multicentre study showed steroid-sparing effect of Belimumab in #SLE. At 2 years, proportion of patients on =>10mg/d decreased from 52% to 3%. 18% and 13% achieved LLDAS and DORIS remission. Support its use esp. in those relying on glucocorticoids @RheumNow https://t.co/ad5XH3pmYc
Md Yuzaiful Md Yusof ( View Tweet)
