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Rheumatology Roundup - ACR 2023
Drs. Jack Cush and Arthur Kavanaugh discuss highlights and key takeaways from ACR 23.
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Here at Last: Treatment Options for VEXAS
We have known about the VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome for nearly 3 years, but there has been relatively little to say about how to treat it. To date there have been over twice as many publications about VEXAS (263 publications) as there have been patients described with respect to treatment strategies (116 patients). One of the late breaking abstracts may finally have rectified this imbalance.
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Watch: Another TYK2 Ticks the Boxes
Dr. Janet Pope discusses late-breaking abstract L12 presented at #ACR23.
https://t.co/1SGuIFOWt6 https://t.co/tb4LRbmfiI
Dr. John Cush RheumNow ( View Tweet)
JAKi, especially BARI, may be useful and safe in controlling both pulmonary and joint disease in RA-ILD patients, even in refractory cases. Evolution of FVC and DLCO remained stable in first 12 months. Serrano-Combarro A, Abst#2174 #ACR23 @RheumNow https://t.co/82mMn5oh15 https://t.co/e7wrgmTOTA
Dr. Antoni Chan ( View Tweet)
Serrano-Combarro et al. JAKi in RA-ILD. 73 patients on JAKi (74% Bari). Many had prev received abatacept/rituximab. HRCT improved/stable in 76%. Dyspnoea stable/improved in 95%. Abstr#2174 #ACR23 @RheumNow https://t.co/j6SiEzSRif
Richard Conway ( View Tweet)
Long-term abatacept in UIP RA-ILD. 233 patients, median 22 month follow-up. Sustained benefits to previous data. ABA was withdrawn in 50 patients (21.5%) (ILD worsening 20, joint worsening 15, serious infections 7, others 8) Abstr#2165 #ACR23 @RheumNow https://t.co/SinE4GgFRE https://t.co/M1Nnce58OE
Richard Conway ( View Tweet)
Who gives a ‘JAK’ why and how they work, as long as they do!
Several abstracts have studied the mechanism of action of JAKi in various diseases. JAKi alter many other mediators affected by the JAK STAT pathway. #ACR23
https://t.co/xqQF8SULgp https://t.co/DZtEly8GEq
Dr. John Cush RheumNow ( View Tweet)
In this Ph2b RCT of TAK-279 (TYK2i), pts w/ PsA given 15mg & 30mg achieved an ACR20 response at wk 12 vs. PBO(53.3% and 54.2% vs 29.2%, both p = 0.002)
⬆️common TEAEs: Npharyngitis, URTI, headache & rash
#ACR23 ABSL12 @RheumNow https://t.co/T6swJgw6vE
sheila ( View Tweet)
Clinical Year in Review at #ACR23
By @philseo (@jhrheumatology)
Review some of the most impactful scientific studies in #Rheumatology in the past year! 🍕 https://t.co/ystEjzrU8u
Mithu Maheswaranathan, MD ( View Tweet)
Anterior uveitis incidence across different axSpA treatments
Large review and meta-analysis on TNFi, IL-17i, JAKi
Immunomodulatory therapy protective against uveitis flare
Greatest in TNFi and JAKi
@RheumNow #ACR23 Abs# 2550 https://t.co/l3BTL3GuRt
Robert B Chao, MD ( View Tweet)
Who knew @FDA_Drug_Info presented #ACR23 posters?! I thought they just issue statements if there was information to be shared! Abst#1822 Bari and Toci use during the pandemic for #COVID19 did not show new safety signals. 1 case HBV reactivation with bari @RheumNow https://t.co/zd7TELsV2j
TheDaoIndex KDAO2011 ( View Tweet)
TM83 #ACR23 @RheumNow
45yo M b/l sacroiliitis, Rx MTX -> ADA -> MTX + Tofa. No improv
Low Ca, & Phos, ALP 239. Nml Vit D, High PTH.
DEXA: Osteoporosis
FGF23 high
PET/CT showed soft tissue density in nasal septum, few cortical breaks
Dx: oncogenic osteomalacia 2/2 malignancy https://t.co/EOcYNtovBy
Eric Dein ( View Tweet)
How do we treat #VEXAS - UBA1 mutation
Large multicenter cohort - 110 pts, 99% M
Confirms the benefit of JAKi and tocilizumab
Others not so much
@RheumNow #ACR23 #ACRBest
#abstL03 https://t.co/tRjO31IHiD
Bella Mehta bella_mehta ( View Tweet)
Interesting counterpoint to a tweet from a few days ago re:black box warning for JAKs
No change in utilization rates post black box... maybe people had already baked this into the cake by then?
@RheumNow #ACR23 Abstr 2142 https://t.co/K9cWbRSWV6
Mike Putman EBRheum ( View Tweet)
#ACR23 Late-Breaking Abstr#L09 In a crowded market, you’ve got to stand out. Phase 2 RCT of LNK01001, a highly selective JAK1-i in China: improvement in ACR 20,50,70 vs PBO at WK12. Those in PBO who didn’t meet ACR20 improved after receiving Tx. Very low infections @RheumNow https://t.co/ZbJFNHOtFT
Md Yuzaiful Md Yusof ( View Tweet)
A#L09 #ACR23 @RheumNow
New JAK! LNK01001
Chinese pts with mod-severe RA, csDMARD failures
12mg/24mg/PBO: W12: ACR20 60/73/31%, ACR50 40/42/9, ACR70 12/21/2%
Stat signif diff reached at wk 1 for ACR20!
Improved DAS28, HAQ-DI
Wk24 ext: 91% remain in ACR 20
AEs: HLD noted https://t.co/RXOMzxGOTy
Eric Dein ( View Tweet)
Phase 2 RCT. Selective JAK1i LNK01001 in RA. 156 patients, 24 week (12 week PBO controlled). Abstr#L09 #ACR23 @RheumNow https://t.co/hHjL1yFH0H https://t.co/Qls4zRrRGH
Richard Conway ( View Tweet)
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)
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)
