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Gender Differences in Axial Spondyloarthritis
Rheumatic conditions such as SLE and RA exhibit female predominance. In contrast, increasing evidence suggests that gender differences occur in axial spondyloarthritis in terms of time to diagnosis, clinical manifestations, treatment outcomes and quality of life.
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Abstr #2192 risk of serious infxn in newborns of mothers on TNFi by placental transfer
- % serious infection in TNFi in high vs low placental transfer (2.1% vs 1.6%)
- HR (high vs low) 0.98 (95% CI 0.36-2.61)
- No significant difference in risk of serious infxn
@RheumNow #ACR22 https://t.co/7Lfpf7PERu
Akhil Sood MD AkhilSoodMD ( View Tweet)
Which is better for CV risk in RA:
triple therapy DMARDs or TNFi?
TARGET study
n=159 using PET/CT surrogate (endpoint responsiveness👀)
- either led to benefit
- both equally good
- benefit *not* linked to change in DAS28
A direct CV effect of RA Rx?
ABST2215 #ACR22 @RheumNow https://t.co/4FPvSbfGsD
David Liew drdavidliew ( View Tweet)
Flatman et al. Risk of infections in children with third trimester TNFi use, high vs low (CTZ, ETN) placental transfer. No difference but wide CIs, aHR 0.98 (0.36, 2.61) @RheumNow #ACR22 Abstr#2192 https://t.co/350UxX9bkL https://t.co/29uOtek8w7
Richard Conway RichardPAConway ( View Tweet)
Are TNFi or IL-6Ri safe in rheumatic irAEs from ICI Rx?
Multiple big US centers retrospective:
TNFi, IL-6Ri vs MTX
p>0.05, but may be approx 2x risk of cancer progression
Has made me more cautious about TNFi, IL-6Ri - use MTX when you can
Lovely work! ABST1669 #ACR22 @RheumNow https://t.co/cfAT1pQZ7I
David Liew drdavidliew ( View Tweet)
Maya Buch on major adverse CV events in tofa vs TNFi. Post-hoc analysis of phase 3b/4 data looking at cohort enriched for CV events.
@RheumNow #ACR22 #LateBreaking
Julian Segan JulianSegan ( View Tweet)
L06 #ACR22 ORAL Surveillance Updates!
Composite of all ischemic CV events and HF did NOT show difference b/w TOFA vs TNFi
But, MACE numerically higher with Tofa w/ h/o ASCVD
Highest CV risk in TOFA 10 mg BID, 2/2 VTE risk
Most important risk is pt's individual risks
@RheumNow https://t.co/jPPX7f5GRE
Eric Dein ericdeinmd ( View Tweet)
Guimarães et al Portugese registry data suggests similar retention rates in change of MOA compared to 2nd TNFi following failure of 1st TNFi. @RheumNow #ACR22 Abstr#2149 https://t.co/Er2FKwYdRv https://t.co/uMPSfMkjfa
Richard Conway RichardPAConway ( View Tweet)
Ogdie @AlexisOgdie et al. CorEvitas, PsA treatment after 1st line TNFi failure. Switching MOA probably more effective @RheumNow #ACR22 Abstr#1600 https://t.co/vy8gxDaYxZ https://t.co/NmkESbSNfL
Richard Conway RichardPAConway ( View Tweet)
Does lifestyle impact Tx. response?
#Abstr 1510 looked at effect of lifestyle on TNFi response in #axSpA
- The study found higher BMI (obese, overweight) and smoking were less likely to respond to TNFi
- Important to discuss lifestyle when starting tx.
@RheumNow #ACR22 https://t.co/z98DFMLxu3
Akhil Sood MD AkhilSoodMD ( View Tweet)
Abs 1417 finds physicians prefer ABA over TNFi for RF/ACPA+ pts w/ higher disease severity, older age, the presence of extra-articular manifestations, and comorbidities such as heart failure. My question: Trouble getting it first line? #ACR22 @RheumNow https://t.co/tlFMgjgDNM https://t.co/ukoeLgSSUd
Dr. Rachel Tate uptoTate ( View Tweet)
Jones et al. Non-smokers, normal BMI, and current drinkers! with AxSpA more likely to respond to TNFi. @RheumNow #ACR22 Abstr#1510 https://t.co/inCz2sAyj5 https://t.co/K27ptuLV7Y
Richard Conway RichardPAConway ( View Tweet)
#ClinicalPearl woman with non-radiographic axSpA have LESS inactive disease vs MEN but NOT true if radiographic axSpA. 5 yr global study N=2633, independent of TNFi use - not sure why there are differences. Misclassification dx- unlikely. abst#1614 #ACR22 #ACRBest @RheumNowNews https://t.co/coNjwHOkLP
Janet Pope Janetbirdope ( View Tweet)
CorEVITAS Abs 1499 #ACRbest #ACR22 cycling to a second line TNFi provides limited benefits to pts with AxSpA who discontinued a first line TNFi. @RheumNow
https://t.co/fKDa5kPfXN https://t.co/CtMCj2Ihgc
Dr. Rachel Tate uptoTate ( View Tweet)
Papagoras et al. Serum GM-CSF increased in AxSpA and persists despite TNFi. Are we going to have a trial of mavrilimumab in AxSpA then? @RheumNow #ACR22 Abstr#1156 https://t.co/wCFsY9nC1p https://t.co/lrQQ7tIX4x
Richard Conway RichardPAConway ( View Tweet)
Lifestyle modifications can affect tx response with TNFi in axSpA!
Accdg to this study fr Prof GJones, ✳️Smokers, overwt & obese pts are ⬇️ likely to achieve treatment response to TNFi vs. nonsmokers & normal wt pts
Smoking cessation, wt mgt is key!
#ACR22 @RheumNow ABST#1510 https://t.co/PBFcj6zKVD
sheila RHEUMarampa ( View Tweet)
Once again, high BMI and smoking associated with substantial decrease in TNFi response for treatment of axSpA.
Easier said than done however. How are you helping pts lose weight or stop smoking?
Abs#1510 @RheumNow #ACR22 https://t.co/ircLkuXhCs
Robert B Chao, MD doctorRBC ( View Tweet)
Dr PMease et al looked into impact of TNFi cycling in their #axSpA cohort:
💠After 6mos on 2nd TNFi, only 15% had ASDAS-LDA, 7% MCID in ASDAS, 8% >50% improvement
💠Cycling to 2nd TNFi limited benefits
⬇️sample size, worth further investigation
#ACR22 @RheumNow ABST#1499 https://t.co/OVJxezdipW
sheila RHEUMarampa ( View Tweet)
#abs0948 #acr22 @rheumnow perception on fertility&ART in pts w/rheum Dx: 60% believe their Dx affects fertility/25% believe meds do: most cited MTX, steroids, TNFi, HCQ, NSAIDs. 92% heard of ART but unsure if safe or successful w/their Dx. Hx of infertility 29%/only 52% go w/ART https://t.co/lmaM773gP5
Olga Petryna DrPetryna ( View Tweet)
Early TNFi use and cardiovascular events in AS
Abstract #0415 #ACR22 @RheumNow
📍17.6k patients, 91% male, 80% white
📍TNFi initiators were younger with lower prev. of HTN and DM
📍TNFi was associated with higher risk of incident CVD, CVA, and MACE https://t.co/7bCkfk7EYY
Catherine Sims, MD DrCassySims ( View Tweet)