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Are there people looking at steroid-sparing therapy as irAE treatment or prevention?
@CCalabreseDO: are there ever
#ACR21 irAE Study Group @RheumNow
(also @NAbdelwahabMD @ReidMDMPH on stage) https://t.co/CLmNaLB68O
David Liew drdavidliew ( View Tweet)
ACR21 Best Abstracts We Saw - Day 3 (Monday)
The third day of ACR 2021 took a big leap in online content. Here is a compilation (with links) of presentations were the “ACRBest” as seen by our RheumNow faculty.
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Dr. Furie thinks that pulse IV steroids are more effective than oral high dose steroids. If you use pulse IV, you can then use a lower oral dose of prednisone w/faster taper. Will he mandate pulse IV steroids w/his next trial? ...long pause.. No. #ACR21 @rheumnow
TheDaoIndex KDAO2011 ( View Tweet)
#PJP prophylaxis debate at #lupus hub if on #prednisone + immune suppression. #SLE has ⤴️septra side effects. Don’t know right answer. NNT v NNH is unknown. I don’t use it in #SLE. @RheumNow #ACR21 8M212
Janet Pope Janetbirdope ( View Tweet)
#ILD in #rheumatic diseases. When to use #glucocorticoids and immune suppressive sand anti fibrotic. V clear but harder in real world! @RheumNow #ACR21 #ACRBest https://t.co/R4V5ZggRsu
Janet Pope Janetbirdope ( View Tweet)
Steroids can cause co-morbidities which increase CV risk, but can PNL directly increase CV event (MACE) risk in RA?
30d PNL➡️15% increase in MACE in next 30d
(independent of underlying CV risk, RA dx activity)
PNL actively confers risk!
@BethIWallace #ACR21 ABST1428 @RheumNow https://t.co/cuL69n7cx3
David Liew drdavidliew ( View Tweet)
Plenary Abs#1428 #ACR21
👉🏼Long-term #steroid use is common in RA incl in pts with high risk of #MACE
👉🏼30days of steroids ➡️ 15% increased odds of MACE
@RheumNow
https://t.co/fCM3m04ruS https://t.co/FWGmAatYu5
Mrinalini Dey DrMiniDey ( View Tweet)
26K Veterans data with RA #ACR21 plenary abst#1428
30 days on glucocorticoids - ⬆️15% odds of Major Adverse Cardiovascular events @RheumNow @BethIWallace https://t.co/BOram4o2rp
Bella Mehta bella_mehta ( View Tweet)
Role of GC on MACE in RA:
US database analysis 26000+pts
23% on GC >90d/6mo
Each 30days of GC dispensed ⏭15% increase in odds of MACE in the following 6month period!
Adjustment on several confounders but not disease activity.
#Abts1428 #ACR21 @RheumNow https://t.co/prdA7D5fLz https://t.co/F3wCcRAfuf
Aurelie Najm AurelieRheumo ( View Tweet)
Fautrel describes a series of 13 #AOSD (Stills) pts with Pulmonary arterial HTN (cath confirmed) - seen exclusively with women, 85% and all were on DMARDs - 31% MTX, 69% IL-1i, all on steroids- 5 deaths, 3 yr Survival 74% (same as PAH) #ACR21 Abstract 1100 https://t.co/qR21MdYG3A https://t.co/WN38ifgtT6
Links:
Dr. John Cush RheumNow ( View Tweet)
Baricitinib for *relapsing* GCA (Th1+Th17)
w abbreviated steroid wean (15-22w)
Despite being tougher to treat:
100% off steroids at 24w
93% off steroids at 52w
no ischemic Sx
promising as another GCA Rx option!
(post-cessation 4pts flared)
@MayoClinic #ACR21 ABST1396 @RheumNow https://t.co/dqFnHQYogk
David Liew drdavidliew ( View Tweet)
ACR21 Best Abstracts - Day 2
The RheumNow faculty reporters have been scouring and reporting on the best abstracts from the ACR. Here is a sampling of their choice abstract presentations reported during ACR 2020 Day 2 (#ACRbest).
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If obvious dermatomyositis, you don’t need EMG for dx but may use for severity of involvement or if failing Rx or r/o steroid myopathy. For ?polymyositis ALWAYS do bx and often do EMG as broad differential #ACR21 @RheumNow https://t.co/L1xu3OuRYJ
Janet Pope Janetbirdope ( View Tweet)
#ACR21 #Abstr0865 It’s time for T2T to achieve LLDAS in #lupus. In a study of N=2040 pts, mortality was 2.3% mainly due to infection. Remission off steroid was the best but only met in 14%. LLDAS-50 achieved in 48% pts and ⬇️mortality by 56% @RheumNow https://t.co/CddqMuFIOM https://t.co/g346Cbybep
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
Great talk by @saadhealth #ACR21 & interesting to compare myocarditis irAEs to inflamm arthritis irAEs:
similar:
- importance of confirming dx well
- cautious adoption steroid-sparing Rx
different:
- clear benefit hard/early Rx
- dx metrics aided by tech
#ACR21 7S404 @RheumNow https://t.co/mFjM3ZlZaP
David Liew drdavidliew ( View Tweet)
Does #comorbidity burden affect treatment of #InflammatoryArthritis?
Abs#0577 #ACR21
👉🏼~6500pts; 11 types of IA
👉🏼Higher comorbidity burden➡️more likely to receive steroids than TNFis
👉🏼Are patients w/ IA & multiple comorbidities receiving suboptimal therapy?
@RheumNow #ACRBest https://t.co/iIERb0wL4Y
Mrinalini Dey DrMiniDey ( View Tweet)
#ACR21 #Abstr0866 Data from #COVID19 GRA Registry showed predictors of poor COVID outcome in 1922 #lupus pts:
Older age
Male
Areas outside Europe, 🇺🇸🇨🇦
Infection <June 2020
Any Corticosteroid dose
Not on therapy
On Rituximab
Comorbidities
⬆️disease activity
@RheumNow #ACRBest https://t.co/u0GF3aDsFA
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
Novel treatment options for Giant Cell Arteritis
Giant cell arteritis is associated with significant treatment related morbidity due to the dependence on glucocorticoids as a treatment option. After sixty years of therapeutic stagnation, these are exciting times in the management of GCA. At this year's ACR Convergence meeting, encouraging data will be presented on options for GCA.
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@benjaminsutu @RheumNow Always steroids first, we learned that the hard way in GUSTO - but yeah, probably something after that, and TCZ is our only b/tsDMARD choice... for the time being
(at #ACR21 - mavrilimumab, baricitinib, secukinumab...)
David Liew drdavidliew ( View Tweet)
Treatment for VEXAS syndrome. It is steroid responsive. Avoid IL-1 inhibitors severe skin reactions at injection site, bone marrow transplant may be curative @RheumNow #ACR21 Session6S410 L Wilson, DO Cordona https://t.co/eQ1KVDiKKV
Dr. Antoni Chan synovialjoints ( View Tweet)