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EULAR 2023 – Day 2 Report
Day 2 at the international EULAR Congress meeting is always bigger and busier. There were sessions on JIA therapies, crystal arthritis, novel drugs for SLE and Sjogren's, early RA and preclinical RA interventions, IgG4 disease, osteoporosis and the growth and application of artificial intelligence in medicine and rheumatology.
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Belimumab in Lupus Nephritis
Belimumab is a B-lymphocyte stimulator (BLyS)-specific inhibitor that is FDA approved for the treatment of active lupus and lupus nephritis, based on a few pivotal trials; and now a metanalysis supports its use in active lupus nephritis.
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2022 EULAR Recommendations on Screening and Prophylaxis for Opportunistic Infections
Opportunistic and chronic infections may be rare and are often difficult to diagnose, especially in patients with autoimmune inflammatory rheumatic diseases (AIIRD), that may be immunocompromised.
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Prevalence and Mortality of IgG4-related disease in the USA
A current review of the epidemiology of IgG4-related disease (IgG4-RD) in the USA shows a low prevalence with possibly increasing numbers, owing to increasing awareness of this unique immune-mediated condition.
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We would think that targeted therapies would have reduced GC use in RA.
Well, this is not really the case.
Comaprison of GC use in 1999-2008 vs. 2009-2018
52% of patients remain on GC for>3Mo after initiation & 1/3 still continues after 2 years!
@RheumNow #EULAR23 POS0309 https://t.co/dDkUJFlmEm
Aurelie Najm AurelieRheumo ( View Tweet)
#EULAR2023 #POS0222 Post-hoc Analyses of Phase 3 RCT in Rituximab-treated ANCA vasculitis patients only (65% of total) showed more patients met Remission rate & with lower GC Toxicity vs Pred Taper + RTX at 52 weeks, consistent with Trial Main Results @RheumNow https://t.co/BmiujbhQI9
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
Initial use of glucocorticoids GC as bridging treatment in RA resulted in increase use of GC later, fewer DMARD changes later, van Ouwerkek L, Abst#OP220 #EULAR2023 @RheumNow https://t.co/IjxgQTZ8SE
Dr. Antoni Chan synovialjoints ( View Tweet)
Treatment of IIM, MTX or AZA or IVIG are 1st line (with steroids). #EULAR2023 https://t.co/TDKWxgrST0
Dr. John Cush RheumNow ( View Tweet)
What do we do with PMR patients with subclinical GCA seen on ultrasound?
Well, in these non-blinded cohorts the subclinical GCA pts got more pred.
Was it warranted? Hard to say. If we’re going to look for it, let’s try and figure out what it means
POS0712 #EULAR2023 @RheumNow https://t.co/KmCcE0Nsu9
David Liew drdavidliew ( View Tweet)
Rx of #lupus #SLE The most challenging seems to be longstanding & residual disease activity - damage accumulates over time - esp if #glucocorticoids are used. Consider only as bridging. How to treat #lupus #EULAR2023 Boumpas @RheumNow #ClinicalPearl @eular_org https://t.co/heBbcRAjxO
Janet Pope Janetbirdope ( View Tweet)
Tapering pred in RA - this just rings true from everyday clinic life.
Some patients just seem to hit a wall at PNL 2.5. Sometimes it’s GC withdrawal arthralgias/tertiary adrenal insufficiency, but often it’s genuine inflammation.
I still wonder why?
POS0050 #EULAR2023 @RheumNow https://t.co/JBh26VqPuM
David Liew drdavidliew ( View Tweet)
CareRA trial:
3 months addition of LEF vs. ETA in pts resistant to COBRA-Slim regimen (MTX 15 mg/w + step-down prednisone):
After 2 years, no difference in dis control but those who received ETA early were treated more frequently w/ csDMARD monotherapy #EULAR23 @RheumNow OP0129 https://t.co/YwSoZWi375
Aurelie Najm AurelieRheumo ( View Tweet)
#EULAR2023 #OP0046 With more effective therapies in #lupus, we should aim for bare minimum/cessation of steroid. A study using French database showed:
>12% were on =>5mg Pred/d, this associated with comorbidities & increased costs
14% on high dose Pred weren’t on HCQ
@RheumNow https://t.co/x99Jt9yf1g
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
I swear it is muscle, Doctor!
GLORIA trial substudy
Pred 5 mg/day 2 years in RA pts >65yo:
Weight gain 1kg vs. PBO, no increase or redistribution of fat mass but augmentation in lean mass 💪
Probably explained by better disease control (although NS in study, small sample size)
Aurelie Najm AurelieRheumo ( View Tweet)
#EULAR2023 Abstr #OP0048 What happened if we taper steroid in #lupus patients who are Serologically Active Clinically Quiescent? A cohort study in Asia showed:
- Tapering was NOT associated with subsequent flare
- Tapering reduced damage in those on =>5mg/day
@RheumNow https://t.co/Q6GiaSCgV6
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
Avacopan in GPA
- non-inferior to prednisone for induction remission
- received FDA approval for treatment of severe active GPA in combo with standard therapy and steroids
- should be used in newly diagnosed active or relapsing disease
@rheumnow #RNL2023 https://t.co/My6M5MGBl1 https://t.co/0aPFUeE55Q
Links:
Dr. John Cush RheumNow ( View Tweet)
SAPHYR, presented at #ACR22, unpublished
Robert Spiera at #RNL2023
Phase 3 study for refractory PMR
Sustained remission of disease, less steroids usage, steroid toxicity, and improved PROs
@RheumNow https://t.co/oQJV7gUV3W https://t.co/S1LRBT55Qn
Links:
Dr. John Cush RheumNow ( View Tweet)
Chinese study of 4091 SLE pts, 3% (106) dx w/ osteonecrosis (AVN). AVN risk factors included:
- SLE onset age ≤ 30 (HR 1.6)
- Arthritis (HR 1.6)
- Organ damage (HR 2.6)
- RNP+ (HR 1.7)
- High steroid doses (HR 1.7) https://t.co/DnqhEIWztY https://t.co/aP0uh0oh1x
Links:
Dr. John Cush RheumNow ( View Tweet)
715 women w/ infertility from recurrent implantation failure were randomized to either placebo or prednisone 10 mg/d. Live birth rates were unaffected by pred (37.8% 38.8% w/ PBO; NS), but pred did increase rate of preterm deliveries (11.8% vs 5.5%; P=.04) https://t.co/ey5JDk2Xi5 https://t.co/Rcgphj147r
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Dr. John Cush RheumNow ( View Tweet)
PJP Prophylaxis Needed with Steroids and RTX
The 2023 EULAR Vasculitis guidelines recommends primary prophylaxis with antibiotics, especially in rheumatic disease patients receiving RTX.
https://t.co/eq42bK7MB1 https://t.co/Wk1hOpXanv
Links:
Dr. John Cush RheumNow ( View Tweet)
