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TNFi cycling in axSpA: Results from CorEVITAS Registy study

d Rachel Tate, DO

Data presented at ACR22 shows that cycling through TNFi in axSpA patients with primary lack of efficacy with first line TNFi has limited additional benefit in controlling disease. 

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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 đź“Ť17.6k patients, 91% male, 80% white đź“ŤTNFi initiators were younger with lower prev. of HTN and DM đź“ŤTNFi was associated with higher risk of incident CVD, CVA, and MACE https://t.co/7bCkfk7EYY
Catherine Sims, MD DrCassySims ( View Tweet)
Song et al. Korean study shows better persistence of tocilizumab than TNFi as first-line biologic in RA. No difference in incidence of TB. @RheumNow #ACR22 Abstr#0887 https://t.co/EuQkfDZd77 https://t.co/VxJmKEzAVY

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Richard Conway RichardPAConway ( View Tweet)
Proft @ProftDr et al. NSAIDs+golimumab no better than golimumab monotherapy in reducing spinal progression in AS. But... for high risk patients there may be some benefit - see figure. @RheumNow #ACR22 Abstr#0546 https://t.co/xo9Uy6aX71 https://t.co/vZgaoeEQn4

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Richard Conway RichardPAConway ( View Tweet)
Weinstein et al. GO-BACK. Another TNFi withdrawal study in nr-axSpA. Again showing it doesn't work. 12 months. Only 34% of withdrawal group in remission vs 84% full dose and 68% reduced dose group. @RheumNow #ACR22 Abstr#0545 https://t.co/Fa5YgT9FYk https://t.co/9C8ShI9qjk

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Richard Conway RichardPAConway ( View Tweet)
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Avoid Abatacept in RA patients with a history of cancer?

d Richard Conway, MBBChBAO, PhD

The management of RA patients with a history of cancer continues to be an area of concern. General recommendations are to treat patients with a history of solid organ cancer as no different to any other RA patient. Recently, the ORAL-Surveillance study demonstrated evidence of a greater risk of cancer with tofacitinib than with TNF inhibitors. In this setting, two posters both reassure and raise a new cause for concern.

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Advance growth

Practical use of JAK inhibitors in select groups in Axial SpA

d Antoni Chan, MD, PhD

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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Interesting data on TNFi use in ankylosing spondylitis. Early TNFi use, compared to no TNFi associated with higher CVD, stroke and MACE. @rheum_cat any thought on why? and why there were so many non-TNFi users (15k vs. 2k)? Abs#0415 @RheumNow #ACR22 https://t.co/PVkt8gPHFW
Robert B Chao, MD doctorRBC ( View Tweet)
@rheum_cat et al Abs 0415 TNFi initiation early in AS dz course (compared to no initiation) showed higher risk of incident CVD, stroke & MACE individually! Residual confounding by indication cannot be excluded. Were TNFi tx pts sicker? #ACR22 @RheumNow https://t.co/ERoDhS2yOY https://t.co/8tto5AIUSP

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Dr. Rachel Tate uptoTate ( View Tweet)
Another study showing treatment withdrawal does not work. Golimumab withdrawal in nr-axSpA is inferior to continued treatment or tapered treatment, leading to more disease flares. Abs#0545 @RheumNow #ACR22 https://t.co/CBRnVdxXVo
Robert B Chao, MD doctorRBC ( 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)
Liew @rheum_cat et al. No evidence of cardioprotective effect of early initiation of TNFi in AxSpA. In fact seemed to be associated higher risk! CVD (HR 1.17), stroke (HR 1.24), and MACE (HR 1.22) @rheumnow #ACR22 Abstr#0415 https://t.co/a9lpxQuMB9 https://t.co/GdGfYxcAH6

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Richard Conway RichardPAConway ( View Tweet)
Therapies for AS and nr-AxSpA are coming together. Both AS and nr-AxSpA present with similar burden of disease. TNFi, IL-17i and JAKi now approved for use in nr-AxSpA. Jose U Scher, SpA Review @RheumNow #ACR22 https://t.co/vcHcd7OyAU
Dr. Antoni Chan synovialjoints ( View Tweet)
England et al. Influence of FVC on choice of b/tsDMARD in RA-ILD. FVC predicts hospitalisation and mortality. However, it did not appear to influence choice of b/tsDMARD. Overall 67% of RA-ILD patients initiated TNFi, weird! @rheumnow #ACR22 Abstr#245 https://t.co/swuNHv96WD https://t.co/vy5FUPnNjo

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Richard Conway RichardPAConway ( View Tweet)
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AS, Lupus and Subclinical RA: What I'm looking forward to at ACR22

d Robert Chao, MD

As we approach ACR22, there are many things to be excited about, especially with the reintroduction of in-person attendance. My attention this year is in research being presented in these three areas: ankylosing spondylitis; lupus management and treatment; and, subclinical RA.

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ACR22 Presents New Data on JIA Clinical Remission with Combo DMARDSs

d EurekAlert!

New research being presented this week at ACR Convergence 2022, demonstrated that polyarticular juvenile idiopathic arthritis patients were more likely to achieve clinical remission with a combination of conventional and biologic DMARDs compared with other consensus treatment plans by the Childhood Arthritis and Rheumatology Research Alliance (CARRA).

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2022 EULAR Recommendations for Screening and Prophylaxis of Chronic and Opportunistic Infections

d Jack Cush, MD

A EULAR Task force has developed recommendations for screening and prophylaxis of chronic and opportunistic infections in patients with autoimmune inflammatory rheumatic diseases (AIIRD).

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BIOBADASER registry study of 969 axSpA pts (315 females, 654 males; 2000-2019) who initiated a TNFi shows nonresponse (BASDAI50) was more likely in women (p=0.018), older age at the start of TNFi therapy. https://t.co/Zp7PWhEMav https://t.co/1XY0dC0QCW

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Dr. John Cush RheumNow ( View Tweet)

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