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After melanoma, should RA patients stop DMARDs?
These VA data (n=644) showed no mortality signal, and trending to survival benefit with b/tsDMARDs
Provisos over methotrexate, invasive disease etc, but don’t hold off treating the RA because of melanoma
#ACR25 ABST2237 @RheumNow https://t.co/l9n1V6YVln
David Liew drdavidliew ( View Tweet)
#IL2 #Rx in active #SLE?
Maybe 🤔
IL2 is tricky - low dose May help #SLE but too much of a good thing may have a neg impact.
RCT of IL2i in #SLE gave a good dose response and improved TRegs.
#ACRBest #ACR25 @RheumNow @ACRheum #LB01 https://t.co/F61qz5x5We
Links:
Janet Pope Janetbirdope ( View Tweet)
Infection vs steroid sparing in PMR/GCA/AAV studies with steroid-sparing Rx
GiACTA (1, top right) aside,
- low infection rates
- the more steroid saved, the less the infection risk
Infection risk in vasculitis is driven by steroid, not DMARD
#ACR25 ABST2526 @RheumNow https://t.co/UprbxUQyQC
David Liew drdavidliew ( View Tweet)
Data from this retrospective cohort study by Alomari et al show that SLE pts on SGLT2is
⬇️rates of PulHPN (OR 0.79)
⬇️all-cause mortality (0.49)
⬇️hospitalizations (OR 0.56)
⬇️LN (OR 0.4)
vs non-SGLT2i users(p<0.001)
Impt role of SGLT2i as adjunct tx
#ACR25 @RheumNow Abs2438 https://t.co/NQJTzQwRCt
sheila RHEUMarampa ( View Tweet)
Post hoc eval of relapses from MANDARA, MEPO vs BEN in EGPA
30% of pts had relapse, 81% of which were asthma +/- sinonasal disease
Remainder were mostly muscle involved, only a few mononeuritis
Mostly as expected; useful epi data for clinic
#ACR25 @RheumNow Abstr#1769 https://t.co/IKKolMZJlF
Links:
Mike Putman EBRheum ( View Tweet)
Hindosh et al. Semaglutide associated with reduced synovitis, joint pain and swelling, in RA. @RheumNow #ACR25 Abstr#2286 https://t.co/6Xs4um5l32
Richard Conway RichardPAConway ( View Tweet)
Bremer et al. Earlier initiation of biosimilar adalimumab (vs csDMARDs) may result in cost-savings. Reduced cost of tests, consultations, and hospitalisations. @RheumNow #ACR25 Abstr#2271 https://t.co/lHaSiX3WLd
Richard Conway RichardPAConway ( View Tweet)
Is taking NSAIDs +TNFi better for the joints?
Abstract 2359: In radiographic axSpA, NSAIDS + TNFi associated with
-fewer syndesmophytes 36% vs 58% TNFi
- no significant effect on hip structural changes
- @RheumNow #ACR25
Akhil Sood MD, MS AkhilSoodMD ( View Tweet)
CD19 counts during RTX maintenance therapy do NOT perform well in assessing the risk of relapse
Interestingly, only younger age was associated with relapse in this retrospective study
@RheumNow #ACR25 Abst 1766 https://t.co/crsFKJ0LnP
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
Zavada et al. 52 patients. bDMARD therapy improves sexual function at 6 months in r-axSpA. Improvements in function, desire, satisfaction in those with baseline erectile dysfunction @RheumNow #ACR25 Abstr#2346 https://t.co/IUMGCFnXZh
Richard Conway RichardPAConway ( View Tweet)
Konsta et al. Adding NSAID to TNF inhibits spinal but not hip radiograpic progress. 262 patients, TNF+NSAID 100, TNF alone 162. New syndesmophytes 36% vs 58%. ΔmSASSS-score/year 0.1 vs 0.7. No effect on progression of hip radiographs. @RheumNow #ACR25 Abstr#2359 #ACRBest https://t.co/k9j2M2E3ze
Richard Conway RichardPAConway ( View Tweet)
Paging the pharmacist
Abstract 1973: Dedicated clinic pharmacist -> benefits
Tasks included:
🔹 74% PA support
🔹 55% patient education
🔹 40% medication management
~50% pts had clinically meaningful improvement
Providers report ↑ care quality & ↓ admin burden
@RheumNow #ACR25
Akhil Sood MD, MS AkhilSoodMD ( View Tweet)
MAINRITSEG: RTX vs. AZA for maintenance in EGPA
RTX not superior in primary remission outcome
RTX favored in secondary outcome of remission with pred <4mg daily
Limitation: only ~50% pt with FFS 1+
@RheumNow #ACR25 Abst 1765 https://t.co/dh5ZWCT12T
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
Girolami et al. VA study. Safety of DMARDs in RA following melanoma. 644 patients. 3 year all cause mortality. No significant difference, but graph sure looks like b/tsDMARDs are better. No melanoma specific mortality/recurrence data however. @RheumNow #ACR25 Abstr#2237 #ACRBest https://t.co/IN4LDkioT7
Richard Conway RichardPAConway ( View Tweet)
HCQ weight-based dosing: out
HCQ whole blood monitoring: in
Whole blood levels more precisely balance risks of SLE flare (under-dosing) vs. toxicitiy (over-dosing)
Many pt on <5 mg/kg had supra-therapeutic blood levels with risk for toxicity
@RheumNow #ACR25 #ACRBest Abst 1722 https://t.co/qIbACxAW39
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
Passive transfer of Ab can occur w #IVIg
#Ab can occur from IVIg passive transfer incl HepB
IVIg - if pt has #cryoglobulins
👇
Can precipitate severe #cryo flare
#ClinicalPearl
Secrets & Pearls session
#ACR25 @RheumNow @ACRheum https://t.co/tTaSuVy1yQ
Janet Pope Janetbirdope ( View Tweet)
Pooled data fr diff SLE cohorts by Dr SGarg et al were evaluated to determine an upper threshold tx range of HCQ
750-1150 ng/mL: safe & effective HCQ levels
>1150ng/mL-supratx, no added tx benefit
CKD st >/=3: 2x ⬆️odds of toxic hcq levels
#ACR25 @RheumNow Abs1722 #ACRBest https://t.co/RFx1VO0bov
Links:
sheila RHEUMarampa ( View Tweet)
3rd plenary session!
#1722 Defining safe HCQ levels in SLE: whole-blood 750-1150ng/mL= therapeutic range; >1150ng/mL ➡️ ~2× toxicity risk; <750ng/mL ➡️ higher flare risk
CKD ≥3 increases odds of supratherapeutic levels
New era of precision monitoring in SLE?
@RheumNow #ACR25
Mrinalini Dey DrMiniDey ( View Tweet)
Plenary 3, HCQ blood levels in SLE
HCQ level > 1150: 1.9x risk of HCQ toxicity
HCQ level < 750: 1.4x risk of active SLE
HCQ dose < 5mg/kg: 1.9x risk active SLE
My take home? Blindly reducing dose to <5mg/kg is BAD; use levels instead!
@RheumNow #ACRBest #ACR25 Abstr1722 https://t.co/UCBPAKAyon
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Mike Putman EBRheum ( View Tweet)
#ACR25 Please find my video and take on Abstr#0803. Should we use Belimumab before- or after a trial of concentional immunosuppressant in #SLE? @RheumNow
https://t.co/ExIvrdJXw5 https://t.co/AVb5ohWwXZ
Links:
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
