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Who gives a ‘JAK’ why and how they work, as long as they do!
Several abstracts have studied the mechanism of action of JAK inhibitors (JAKi) in various diseases. JAKi alter many other mediators affected by the JAK STAT pathway. For instance, T cell signature in blood that is proliferative was associated with a response in RA.
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Bimekizumab is Coming… in Third Place
Of the many exciting advancements for patients with psoriatic arthritis at ACR Convergence, one upcoming therapy stood out: the dual IL-17A/F inhibitor bimekizumab. Nearly two dozen bimekizumab abstracts will be featured at this year’s meeting and it recently received authorization in Europe and the U.S. for psoriasis. That makes this the year I plan to figure out where this drug will be useful for my patients with PsA.
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Large VA study of >1k RA-ILD pts
No difference in risk of respiratory hospitalization or death in RA-ILD pts using TNFi vs. nonTNFi/JAKi
Data does not support avoiding TNFi in RA-ILD
@RheumNow #ACR23 Abs#1582 https://t.co/LTNLXEIAPo
Robert B Chao, MD ( View Tweet)
Ab#1582 @RheumNow #ACR23
RA-ILD outcomes of TNFi v non-TNF b/tsDMARD
VA Data, propens match emulation study
No incr risk of death in TNFi vs non-TNFi
But are TNF safe?
- Don't support systematic avoidance. But are there specific pops - unsure. Don't answer if efficacy in RA-ILD https://t.co/AApEjZs4DM
Eric Dein ( View Tweet)
Important plenary session, RA-ILD outcomes in VA cohort study
No difference in death/hospitalization for TNF vs non-TNF treated patients. Jives w/my priors; I do NOT avoid TNF in RA-ILD
Encouraging if you (like me) prefer RA-active tx for RA-ILD 😉😆
@RheumNow #ACR23 #ACRBest https://t.co/TIDzMLOfs4
Mike Putman EBRheum ( View Tweet)
Non TNFi b/tsDMARDs vs TNFi in RA-ILD. New-User, Propensity Score Matched Study. 454 patients. No difference! resp-related hospitalisation aHR 1.22 [0.92, 1.60] No difference mortality. Abstr#1582 #ACR23 #ACRbest @RheumNow https://t.co/HzzVo9dJHi https://t.co/mZuHq4GShU
Richard Conway ( View Tweet)
The order of use will affect the safety and effectiveness of drug Rx in #Rheumatoid #arthritis So if #Rituximab is used in later line #Rx - is looks worse@than ex #TNFi used early. Never forget prescribing bias / confounding the results. @RheumNow @ACRheum #ACR23 https://t.co/JJ8BY7n9VM
Janet Pope ( View Tweet)
Taiwanaise study of factors associated with 5 year mortality in patients after their first biological b,ts DMARDS
A highter risque mortality in RTX and lower in tsDMARD vs TNFi @RheumNow @Janetbirdope @Yuz6Yusof https://t.co/rjpo08Tg46
Dellal ( View Tweet)
ABS0450
⭐️Baricitinib non-inferior as well as superior to TNFi in terms of ACR50 response @ 12w in real world csDMARD refractory RA patients
➡️open-label, T2T w/ Baricitinib (n=102) vs TNFi (n=97)
➡️DAS28-CRP remission (<0.6) in 74% of Bari vs 47% of TNFi
#ACR23 @RheumNow https://t.co/yydS20hNzM
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
TNF AND IL17 was equally effective in Axial SpA!
#ACR23 #Reviewcourse https://t.co/oofQkvsJ3f
Nouf Al hemmadi ( View Tweet)
What if we deliver TNFi to the wrong place?
Delivery of ETA to peripheral lymphatics instead of subcut through a wearable device in 10pts showed:
1- is Safe
2-Reduces DAS28 (but more TJC than SJC)
To be confirmed in larger and controlled study!
@RheumNow #ACR23 ABST0838 https://t.co/IUPpFwjjbj
Aurelie Najm ( View Tweet)
Ph2a Nipocalumab: FcRn blocker
IV15mg/kg TNF IR RA 32 pts
Delta DASCRP -1 vs -0.5 PBO
ACR50 20% vs 0 PBO
DAS Remission 40% vs 16% Only in ACPA+ pts
SAEs 1 infusion related reaction
Not extremely convincing alone
Currently studied in combination w/ TNFi
@RheumNow #ACR23 ABST0839 https://t.co/6wTu2ellhN
Aurelie Najm ( View Tweet)
Ross et al. Fascinating study of infusion of etanercept into lymphatics in RA in inadequate responders to s/c etanercept. DAS28(CRP) reduced 5.40±0.16 to 3.55±0.21, PGA of Disease Activity and Pain decreased by 66% and 77%. Abstr#0838 #ACR23 @RheumNow https://t.co/RIMCS3nmy6 https://t.co/U2689atvmj
Richard Conway ( View Tweet)
DRESS-PS study LTE. 12 month observational extension. 114 patients PsA/AxSpA. Essentially patients TNFi tapered or not in T2T fashion. TNFi dose remained lower in tapering group but it is consistently creeping back up. Abstr#0775 @RheumNow #ACR23 https://t.co/aYoOl6Ccin https://t.co/BtMR95lIfs
Richard Conway ( View Tweet)
#ACR23
Lower persistance of TNFi in women than men in Psa👍🇫🇷🇫🇷🇫🇷 CHU Mondor
@RheumNow https://t.co/27OVLz4aZN
Dellal ( View Tweet)
What are effects of TNFi on Lipids in AxSpA?
Ab#0531 #ACR23 @RheumNow
320 pts w AS - retrosp cohort, first-line TNFi, not on lipid Rx
Chol and TG increase in 1st 3 mos of treatment. LDL & HDL: no signif change
Inflam markers/Lipids correlated - suspect due to anti-inflamm effect https://t.co/qT5qUEOEvO
Eric Dein ( View Tweet)
Is there a difference in secukinumab vs. adalimumab biosimilar on radiographic progression in a subgroup of axSpA pts with syndesmophytes or CRP levels?
Radiographic progression equally low in both drugs
NO difference in syndesmophytes or CRP
@RheumNow #ACR23 Abs#0522 https://t.co/1TBKAxuKPE
Robert B Chao, MD ( View Tweet)
Systemic anti-inflammatory treatments for PsO and PsA including methotrexate and biologics provided cardioprotective effects
Potential cardiovascular benefits of IL-17i and IL-12/23i compared to TNFi
@RheumNow #ACR23 Abs#0498 https://t.co/Np7PSNvFd6
Robert B Chao, MD ( View Tweet)
#CV risk in #AxSpA in Korean population study N=71001, age 42, 71%M but 16% #MTX, 58% #SSZ. #TNFi vs none 30% less CVE. IL17 NO CV reduction but ?confounded by line of #Rx and v large N for TNFi. Study stated PRIOR to IL17i approval #ACR23 @ACRheum @RheumNow L11 poster ?Rx bias https://t.co/3Sft5KUlLa
Janet Pope ( View Tweet)
Join us tonight at 6pm PT/ 9pm ET for our daily #ACR23 recap. https://t.co/0RDwTdzhwS
Dr. John Cush RheumNow ( View Tweet)
