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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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Methotrexate: shall we split up?
Methotrexate is widely used in rheumatic diseases yet poses common tolerance issues, especially for the oral form; and bioavailability is known to be limited for doses over 15mg. In the SMART study, Prasad et al. present the first RCT comparing either single dose (25 mg) or split-dose (10 mg morning, 15 mg evening, same day) once weekly MTX for 24 weeks.
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)
Insights into pathogenesis venous & arterial thrombosis in RA + JAKi
Significant dysregulation of clotting pathways in myeloid & increased clot formation in context of microbial challenge (TLR4)
Observed across all JAKI, but selective JAK3i
@RheumNow #ACR23 ABST1676 https://t.co/nboy0znfAW
Aurelie Najm ( View Tweet)
Suarez-Almazor et al. TNFi in early breast cancer do not impact overall survival, HR=0.75 (0.41-1.37), HR=0.86 (0.55-1.34). Better cancer specific survival HR=0.29 ( 0.09-0.98)! Abstr#1675 #ACR23 #ACRbest @RheumNow https://t.co/qS5W7WehiN
Richard Conway ( View Tweet)
Two-week interruption of MTX for IMIDs enhanced boost of antibody responses after COVID-19 vaccination, sustained at 12, 26 weeks. Consistent across ages, MTX doses, route, IMIDs, primary vaccination platform,COVID-19, Abhishek A Abst#1677 #ACR23 @RheumNow https://t.co/T0KdsGh6vg
Dr. Antoni Chan ( View Tweet)
VROOM 🏎️ study
2 wks interruption of MTX just after COVID vaccine:
-Increase S1-RBD Ab response for 26 wks
-Improves Neutralizing Ab titres (Wuhan Hu-1)
-Leads to more flares wks 4 & 12
Greater effect when MTX dose>15mg
@RheumNow #ACR23 ABST1677 https://t.co/SJmaRHtbRH
Aurelie Najm ( View Tweet)
Abishek et al. 2 week break from MTX enhances response to COVID-19 vaccination, mirroring what we saw for flu. Trade off is short term worsening of disease activity. Abstr#1677 #ACR23 @RheumNow https://t.co/gguRWER81x https://t.co/1hncvDTahH
Richard Conway ( View Tweet)
There was a lower hazard ratio for incident cancer with exposure to TNFi compared to non-TNFi (RTX and ABA) and JAKi. Limits: potential for residual confounding by indication and small number of outcomes per drug class, Xavier S, Abst#1678 #ACR23 @RheumNow https://t.co/vJpFwl6Ivj
Dr. Antoni Chan ( View Tweet)
A#1403 #ACR23 @RheumNow
17% of 1st degree relatives of AS pts have MRI-defined sacroiliitis
Study of 100 subjects w FHx AS
- 13/100: new dx of AxSpA, 7 w radiographic changes
- 4/100: Sacroiliitis without back pain
- 1 periph SpA
- 12 met clinical ASAS classification but not dx https://t.co/V7LCbaDXBe
Eric Dein ( View Tweet)