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ACR23 – Day 3 Report
These year’s annual ACR Convergence has been a success with the return of an insanely active Poster Hall! F2F learning amidst miles of research and many young talented aside wizened establish presenters is such a welcome return to ACR, the way it should be.
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Less (Glucocorticoids) is More in Lupus Nephritis
Dr. Yuz Yusof talks with Dr. Amir Saxena about abstract 0781 at the 2023 ACR Convergence meeting in San Diego, CA.
https://t.co/EriaJvBPj9 https://t.co/x5hNIAgBz2
Dr. John Cush RheumNow ( View Tweet)
L16 @ #ACR23
⭐️Can you discontinue glucocorticoids (GC) & immunosuppressive agent (IM) in stable IgG4-RD (clinically quiescent for at least 12 mo)?
➡️146 pts followed for 18 mo:
👉Group 1: withdraw GC+IM
vs
👉Group 2: withdraw GC… https://t.co/j77xYm9qSN https://t.co/72IwBeEwv9
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
Peng et al. 146 IgG4-RD in remission on immunomodulators+GC. 18 month follow-up. Withdraw IM+GC - 52% flare. Withdraw GC + continue IM 14.2% flare. Continue both 12.2% flare. Clear message that ongoing IM is the way Abstr#L16 #ACR23 #ACRbest @RheumNow https://t.co/3CAQhyTYqq https://t.co/qr1GOSvJYg
Richard Conway ( View Tweet)
L16 #ACR23 @RheumNow
W/d of Immunosuppr and Low-dose steroid in IgG4RD
Gr1: W/d GC+IM, G2: IM alone, G3: Maintain
Relapse rate: G1 52%, G2 14%, G3 12% https://t.co/xe6NLVxUov
Eric Dein ( View Tweet)
Withdrawing immunosuppression and steroids in IgG4-RD
Maintaining immunosuppression with or without steroids associated with low relapse rate
52% of pts who withdrew steroids +immunosuppression relapsed
@RheumNow #ACR23 Abs#L16 https://t.co/xJyDiCkMVD
Robert B Chao, MD ( View Tweet)
Withdrawal of Immunosuppressant and Low-dose Steroids in IgG4-RD Patients with Stable Disease
146 pts - 3 Grps
1: withdraw GC+IM 2:withdraw GC but maintain IM; 3: maintain GC+IM
The maintenance of IMs, with or without low-dose GC, superior to withdraw
#ACR23 @rheumnow #abstL16
Bella Mehta bella_mehta ( View Tweet)
#ACR23 Late-Breaking Abstr#L19 IA steroid can help osteoarthritis knee pain but effect & duration are variable. Phase 3 RCT: improvement in ADP & WOMAC pain favouring TLC5999 (liposomal modification of DEX) vs PBO at all timepoints inc. after repeated injection @RheumNow #ACRBest https://t.co/xUhoFHPExr
Md Yuzaiful Md Yusof ( View Tweet)
Would intraarticular steroids for knee OA be better with a sustained release formulation?
ph3, TLL599 (liposomal delivery dexamethasone) vs normal dex vs placebo
some gains over normal dex
well tolerated
New options always welcome in OA!
@ProfDavidHunter #ACR23 L19 @RheumNow https://t.co/TUrhppHMiD
David Liew drdavidliew ( View Tweet)
What happens when you stop #steroids and/ immunosuppressive Rx in Pts in remission for at least 1 yr in #IgG4 disease?
You are likely guessing correctly
Pts flare! Don’t stop Rx
?taper 🤷♀️
Like RA Rx - if stop Rx = flares
Large RCT from China L16 #ACR23 @RheumNow @RheumNow
Janet Pope ( View Tweet)
Clinical Year in Review at #ACR23
By @philseo (@jhrheumatology)
Review some of the most impactful scientific studies in #Rheumatology in the past year! 🍕 https://t.co/ystEjzrU8u
Mithu Maheswaranathan, MD ( View Tweet)
ARTIC REWIND RCT 3 yrs csDMARD withdrawal
38% 3yrs csDMARDs free remission vs. 80% stable dose gpe
75% recovery after restart
Rx progression 19% in half dose gpe
More use bioDMARDs (18%) & GCs (50%) withdraw gpe
Trends towards lower infections
@RheumNow #ACR23 #ACRBest https://t.co/jhOINV7LLS
Aurelie Najm ( View Tweet)
Low dose #prednisone has (bad) brain effects. An argument to use steroid sparing drugs in #PMR @philseo @ACRheum @RheumNow #ACR23 THINK about steroid sparing Rx in ?all pts with #PMR #Great #debate https://t.co/usQJRNUN8B
Janet Pope ( View Tweet)
Rx of #inflammatory #arthritis with #glucocorticoids doesn’t seem to affect outcomes in #malignancy treated with #checkpoint #inhibitors. Good news as new or flaring inflammatory arthritis as an irAE can be severe. #ACR23 @RheumNow @ACRheum #1055 @CanRIO_Tweets https://t.co/tFIPcQq2X6
Janet Pope ( View Tweet)
There is a dose, duration and recency-dependent relationship between previous GC use and MACE. GC doses 5mg/day, durations of 30 days, and use one year prior to MACE were all associated with an increased risk of MACE, Wallace B Abst#2430 #ACR23 #ACRBest https://t.co/2ExboBvo2W https://t.co/FuqXdFFwqP
Dr. Antoni Chan ( View Tweet)
Nepal et al. No increased risk of GI perforation for tocilizumab in GCA HR 1.05 . Diverticulitis (RR 3.51), IV methylprednisolone (RR 5.41) risk factors. This fits with my priors, steroids are a bigger risk than tocilizumab. Abstr#2560 #ACR23 @RheumNow https://t.co/BAmBQA0kEP https://t.co/zRjmDIkOHp
Richard Conway ( View Tweet)
After attaining #remission or #LLDAS after a flare - HALF flare over f/u esp if tapering pred to <7.5 or 5 mg. #HCQ was protective. 65% got LLDAs and 45% rem in 1/2 yr - longer time to get #remission #2553 #ACR23 @RheumNow @ACRheum #ACRbest Asian cohort of #SLE largest@in world https://t.co/yBBqYJZVOe
Janet Pope ( View Tweet)
Fantastic presentation by Desh Nepal from MCW on risk of GI perforation in patients with #GCA
Low incidence , no association with TCZ, but increased risk with IV methylprednisolone and h/o diverticulitis.
@EBRheum #ACR23 https://t.co/bgvmjAXBEY
Sebastian E. Sattui MD, MS SattuiSEMD ( View Tweet)
GCs on MACE in RA in VA
A#2430 #ACR23 @RheumNow
Not just ongoing steroid usage, also prior usage 1 year ago
5 mg use for 30 days one year ago - increases MACE events by 3%
5 mg use for 90 days one year ago - increases MACE events by 9%
Eric Dein ( View Tweet)
Wallace et al. Dose, duration, recency dependent relationship between GC and MACE. Even 5mg/day, 30 day use, and use 1 year prior associated with risk. 5mg, 7.5mg, 10mg pred for 90 days - 13%, 19%, 27% MACE increase Abstr#2430 #ACR23 #ACRbest @RheumNow https://t.co/50B5nGqxu9 https://t.co/lNrUbZOm0o
Richard Conway ( View Tweet)
