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#ACR23 Great debate: should we use biologics at PMR/GCA onset?
Dr Spiera (Cons)
-Need to agree on clin important diff & flares
-No evidence as disease modifying in GCA
- No need for disease modifying in PMR
-Most pts can be treated with steroid & rapid taper
-Cost @RheumNow https://t.co/ptM8E7EQzF
Md Yuzaiful Md Yusof ( View Tweet)
Plants For Joints continuation data poster was meant to be this am #ACR23 - but withdrawn.
Makes me sad!
Intervention: plant-based diet, exercise, stress Rx for 16w
Abstract reports 1y follow-up:
sustained DAS improvement, despite BMI reductions rebounding
Enticing
@RheumNow https://t.co/4adYf5BTtt
David Liew drdavidliew ( View Tweet)
Coming soon - the great debate!
Should PMR and GCA be treated with Advanced Therapies at disease onset?
@ACRheum @RheumNow #ACR23
Eric Dein ( View Tweet)
Pt w/ refractory SCLE, wants to get pregnant. Dr. Petri's approach is: counsel patient and review meds (e.g PPI's can induce SCLE). She also asks: Where's your hat and sunblock? Get HCQ blood levels b/f starting anifrolumab or belimumab #ACR23 @rheumnow #MeetExpert
TheDaoIndex KDAO2011 ( View Tweet)
Difficult SLE skin dse?
Dr. Mosca reminds us to engage pts in the treatment process including adherence to preventive measures & lifestyle mods (sun protection, smoking)
Other considerations:
+ antimalarials
early use of newer tx? - Anifrolumab
#ACR23 @RheumNow https://t.co/kz8YfcBB2d
sheila ( View Tweet)
#ACR23 Great Debate @ACRheum @RheumNow
Should you start with upfront bDMARD in #PMR and #GCA?
Janet Pope ( View Tweet)
Frailty in PMR @DrTrishHarkins >1/3 are frail or pre-frail. Frailty correlates with PROs - worse mood, pain, fatigue, and QoL. Abstr#1201 #ACR23 @RheumNow https://t.co/pH5yG4AscU https://t.co/QuHmOgpLbi
Richard Conway ( View Tweet)
Telemedicine tools with central evaluation of clinical and imaging (+/- MRI SIJs) information may be helpful in the diagnostic process for patients with suspected axSpA. This reduces the risk of overdiagnosis, Poddubnyy D, Abst#1392 #ACR23 @RheumNow https://t.co/kYEMdqmQF8 https://t.co/2lRg2byGjK
Dr. Antoni Chan ( View Tweet)
Pooled safety analysis of 48 phase II/III/IV trials on secukinumab for tx of PsO, PsA and axSpA
Well tolerated
No new long term safety signals
IBD, malginancy, MACE remain low
@RheumNow #ACR23 Abs#1436 https://t.co/6dzdO5Vpuc
Robert B Chao, MD ( View Tweet)
The Great Debate #ACR23 - and it’s a cracker.
Is early steroid-sparing therapy justified in GCA/PMR? I don’t know, but Rob Spiera and @philseo will battle it out to tell us.
(and ably moderated by the always eloquent @SattuiSEMD)
I’ll put some highlights here ⬇️🧵
@RheumNow https://t.co/ASpuglyENv
David Liew drdavidliew ( View Tweet)
Should #filgo be fil-gone in North America?
Unfortunately #filgotinib is not in NA, but is elsewhere & expanding into other diseases #IBD, IA, etc. Safety at >8yrs is similar to other #JAKi. #CDAI in MTX-IR at 1 yr in 200mg is impressive. @ACRheum @RheumNow #ACR23 1323, 1325 https://t.co/3iAZRcSeq6
Janet Pope ( View Tweet)
Baseline vascular ultrasound predicts clinical outcomes @ 3 months. Subclinical GCA = relapse 37% vs 15%. Higher cumulative steroid dose. @sharoncowley01 @DrTrishHarkins Abstr#1565 #ACR23 @RheumNow https://t.co/b35CkFS0lz https://t.co/suBGR1ByDK
Richard Conway ( View Tweet)
So firstly the no case, and Rob Spiera takes up the case, dictated by the electronic coin toss.
No-one disagrees that we need steroid-sparing options, or that IL-6Ri work in PMR and GCA. But it’s the strategy questions which remain in play:
#ACR23 @RheumNow https://t.co/I2QDU7l6DE
David Liew drdavidliew ( View Tweet)
@RheumNow #ACR23 #GreatDebate
Use Advanced Rx for GCA 1st line?
Spiera: No
No ev for disease modification with early Rx
Lose only reliable biomark of dis activity w IL-6 inhib
No evid of reduced major GC AEs
$$
GCA: treat by GC alone, taper off by 6 m, low threshold to escal https://t.co/QxgAlVKitd
Eric Dein ( View Tweet)
@RheumNow So what might early steroid-sparing therapy in PMR/GCA achieve?
Cure? Superior disease activity control? Minimize damage? Improve QoL/function?
Well, sadly we have a long way to go in defining a lot of this:
#ACR23 @RheumNow https://t.co/QeidAHHm8x
David Liew drdavidliew ( View Tweet)
My blog just published on @rheumnow. We need to screen for CV dz, educate pts about CVD and work with cardiology colleagues. https://t.co/XLc0YHtJ0B #ACR23
TheDaoIndex KDAO2011 ( View Tweet)
Using deep neural network for spinal inflammation in axial SpA, the area under the curve of the receiver operating characteristic (AUC-ROC) curve of the algorithm was 0.87±0.02, comparable with general radiologist Chan S et al Abst#1398 #ACR23 @RheumNow https://t.co/lrQRfc2RwN https://t.co/Fra8cDtQE5
Dr. Antoni Chan ( View Tweet)
Long-term safety of risankizumab in PsA and PsO pts
Over 5k pts, over 4 years
Rates of AEs remained low
malignancy incidence remains low
@RheumNow #ACR23 Abs#1422 https://t.co/GBFke3XmQD
Robert B Chao, MD ( View Tweet)
@RheumNow So in GCA, we don’t know if therapies can truly disease modify at all. There’s a lot of grumbling disease, and it’s unclear whether we can stop long-term vascular issues. And in PMR, we have very little data on early therapy at all.
So what’s the justification?
#ACR23 @RheumNow https://t.co/spAMqfSOy2
David Liew drdavidliew ( View Tweet)
This is pretty nerdy, but I would love a documentary about filgotinib
JAK class wins/fails feel highly idiosyncratic to me
The difference between UPA & FIL from science perspective seems negligible; financially, it's many billions of $$$
@rheumnow #ACR23 Abstr 1325 https://t.co/efGwSSrxz7
Mike Putman EBRheum ( View Tweet)