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Cancer and TNF inhibitors
Cancer risk minimisation is a high priority for people with rheumatic diseases, as it is for the general population. Tumor necrosis factor inhibitors (TNFi) have a long history of association with cancer risk discussions. An oral presentation by Suarez-Almazor et al provided more supportive data on using TNFi in this population.
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#ACRbest Abstracts – Day 2
Our reporters have been prolific in finding the hot abstracts, those that were most attended or those that are getting the most buzz on social media. Here are RheumNow's #ACRbest abstract reports from Monday, November 13, 2023 at #ACR23, covering The Great Debate, SGLPT2 inhibitors in SLE, the SMART Study of MTX, TMP/SMX Prophylaxis, RA-ILD & TNF Inhibitors, cancer research and more.
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Crude drug retention at 1 year was 65% for JAKi, significantly lower than for other modes of action (74%) and TNFi (77%). These results are driven by the severity of the disease of patients on JAKi compared to other MOA. Aymon R Abst#1692 #ACR23 @RheumNow https://t.co/LPDpWdjoLg https://t.co/Ztaz94omd9
Dr. Antoni Chan ( View Tweet)
Obs study, bDMARDs & malignancy
TNFi w/lower risk than ABA/RTX/IL6i & numerically lower than JAKs
I'm a little skeptical... KM curves diverged w/~45 days, seems implausible?
Agree w/first author, possible channeling bias
@RheumNow #ACR23 Abstr 1678 https://t.co/1uL3j6kTSj
Mike Putman EBRheum ( View Tweet)
Sendaydiego et al. Comparative cancer safety b/tsDMARDs. 37,026 patient database cohort study. Compared to TNFi, RTX HR 2.2 (1.5, 3.3) ABA HR 1.7 (1.3-2.4), JAKi HR 1.3 (0.9-1.9). Abstr#1678 #ACR23 @RheumNow https://t.co/bTNtaNJrln https://t.co/qQBM2F2q8N
Richard Conway ( View Tweet)
Ritux (OR 2.2), ABA (OR 1.3), JAKi (OR 1.3) significantly increase risk of cancer vs. TNFi
Cohort of 37000+ RA pts starting bio/tsDMARDs (379 incident cancers)
True biologic effect or confounding by indication in a generally more comorbid population?
@RheumNow #ACR23 ABST1678 https://t.co/suj6mVBEC0
Aurelie Najm ( View Tweet)
#ACR23 Abstr#0840 Could combined JAK1/Tyk2 fare better than Tofacitinib in D2T #RA? Phase 2 RCT showed impressive results; > %50 pts in the higher doses TLL-018 arms achieved ACR50 vs TOF (42%). TOF non-responders at WK12 who switched to TLL-018 improved too @RheumNow #ACRBest https://t.co/Yw6Pvb2PH8
Md Yuzaiful Md Yusof ( View Tweet)
Abst #1584 TMP-SMX⬇️PJP ⬇️SIE,⬇️outpt infx in GPA on RTX. 919 patients: 31% had TMP-SMX, 40% on pred >20 mg/day followed median 496 days. SIE (aHR 0.5, 95%CI 0.3-0.8), outpt infx (aHR 0.7, 95%CI 0.5-0.9), & PJP. Thirteen PJP (all not on TMP-SMX). #ACRbest #ACR23 @rheumnow
TheDaoIndex KDAO2011 ( View Tweet)
Starting soon! Join us tonight at 6pm PT/ 9pm ET for our daily #ACR23 recap. https://t.co/xIBJlYCMQM
Dr. John Cush RheumNow ( View Tweet)
RheumNow’s expanded coverage of the #ACR23 is sponsored in part by Novartis. All content is chosen by RheumNow & its faculty.
Dr. John Cush RheumNow ( View Tweet)
A#1486 @RheumNow #ACR23
STEMI outcomes - SLE v non-SLE
1,000,000 STEMIs, 4000 (0.4% SLE pts)
Younger age in SLE grp 61 v 67 yo
Increased risk of mortality: aOR 1.3 (CI 1.1-1.5, p<0.05)
LOS increased 4.7 v 4.5 d, increased hosp $
SLE: risk of CVD & worse prognostic effect
Eric Dein ( View Tweet)
Trimethoprim sulfamethoxazole (TMP-SMX) negatively associated with serious infections. Rates for adverse events possibly attributable to TMP-SMX per 100 person-years were 29.6 during and 13.4 post exposure. Mendel A, Abst#1584 #ACR23 #ACRBest @RheumNow https://t.co/hHY2bZXrkS https://t.co/2YMoCi1zrx
Dr. Antoni Chan ( View Tweet)
Eder et al. Women with PsA have worse outcomes with advanced therapies. OR favours men for ACR 20, IL-17i (OR 1.76), IL-23i (OR 1.46), IL-12/23i (OR 2.66) and TNFi (OR 1.67). Maybe not JAKi (OR 1.09). Placebo OR 1.04. Abstr#1687 #ACR23 @RheumNow https://t.co/bkDmmmYECF https://t.co/VBLnJzhcaY
Richard Conway ( View Tweet)
PAPILUP: HPV in SLE
A#1479 #ACR23 @RheumNow
65 SLE pts v healthy v HIV+
45% not up to date, one only HPV vax
High risk HPV in 29% SLE pts, similar to gen pop
BUT multiple HR-HPV +abnml cytology higher 15% v 7%, similar to HIV+
Clearance impaired on GCs
RF: lupus duration
#ACRBest
Eric Dein ( View Tweet)
So glad to finally meet the wonderful @uptoTate after three years reporting for @RheumNow #Tweeps IRL #ACR23 https://t.co/S0pyfvxQQC
Md Yuzaiful Md Yusof ( View Tweet)
Large observational study of TNF use among patients with RA & cancer
Overall encouraging, no negative impact on survival
I'm kind of a TNF-truther on this; I don't think they cause ANY increased risk of malignancy
@RheumNow #ACR23 Abstr 1675 https://t.co/KRVlIFxhl8
Mike Putman EBRheum ( View Tweet)
2 RA cohorts w/Breast Cancer
17% TNFi within 1yr after surgery
No diff in overall survival at 5 yr w/ TNFi or csDMARD
Trend towards better BC specific survival w/ TNFi vs. csDMARD only
Worst survival for GC>7.5mg/day
Only 2 yrs follow up
@RheumNow #ACR23 ABST1675 https://t.co/ekKlJ2dP5i
Aurelie Najm ( View Tweet)
Does TNFi use in pts with RA and early breast cancer affect survival?
TNFi did not affect overall survival or breast cancer specific survival compared to cDMARDs
Steroids did increase mortality
@RheumNow #ACR23 Abs#1675
Robert B Chao, MD ( View Tweet)
No significant difference in overall survival in early stage breast cancer (BC) patients treated with TNFi (alone -/+ cDMARDs, in 1st year of BC) and cDMARDs in RA. Those on glucocorticoids had worse survival. Suarez-Almazor M, Abst#1675 #ACR23 @RheumNow https://t.co/lnZx3OpuN5
Dr. Antoni Chan ( View Tweet)
Petri @jhrheumatology data on SGLT2i in SLE
A#1490 #ACR23 @RheumNow
Prior to Rx, average annual change in eGFR was -3.1
After starting SGLT2i, average change decr to -0.9
Did not reach signif (p=0.27)
Average annual incr in UPCR was 0.4 -> 0.37 on SGLT2i, also not signif https://t.co/TviFyAwXbA
Eric Dein ( View Tweet)