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The updated 2024 ACR Guideline for Dx and Tx of #lupus nephritis is here!
Dr. Lisa Samaritano discusses the key recommendations 👇
For all pts: screen for LN, give HCQ and RAAS for pts with ⬆️ proteinuria
GCs in pts w/ LN class III/IV &/or V.
@Rheumnow #ACR24 @rheumarhyme https://t.co/wLVRGktR59
sheila RHEUMarampa ( View Tweet)
Recommend "Triple Therapy" = Glucocorticoids + two other agents
Practically, that means MMF + belimumumab OR CNI for most pts
For the CYC afficionados, the lower-dose EUROLUPUS protocol is preferred
#ACR24 @RheumNow https://t.co/0gRISXSw0c
Mike Putman EBRheum ( View Tweet)
Happening now, new guidelines for mgmt. A few highlights:
Recommend prompt GC therapy, pulse x1-3d followed by oral pred (<0.5mg/kg/d) w/taper to <5mg by 6 months
Aligns with EULAR recs for a much-lower dose than most clinicians currently doing
#ACR24 @RheumNow https://t.co/B71i7FBYlQ
Mike Putman EBRheum ( View Tweet)
Abstract 2503: Clofutriben (HSD-1 inhibitor) minimizes adrenal suppression. Adding clofutriben to prednisolone boosts ACTH & cortisol levels with fewer patients with suppressed morning cortisol (≤5.0 mg/dL) (34% vs 14%).
@RheumNow #ACR24 #GCTox
Akhil Sood MD AkhilSoodMD ( View Tweet)
If you’re starting with DMARD (according to ACR/VF guidelines) tx in TAK - MTX and AZA are probably equivalent options… MMF not so much
@RheumNow #ACR24 https://t.co/jn52ujtspo
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
Hyrich:
ETN originator vs biosimilar initiation
- DAS28 - no signif change at B/L, 6mo, 12 mo.
Switch?
Matched pts in ETN switch v cont originator - good b/l control on Rx
-DAS28 maintained w switch
10% did go back to originator, felt less good tho similar DAS
#ACR24 @RheumNow https://t.co/RHRit5CtUu
Eric Dein ericdeinmd ( View Tweet)
Early observational data suggesting JAK inhibitors can play a role in TAK tx
We have seen this with UPA in GCA this conference… time for SELECT-TAK !
@RheumNow #ACR24 https://t.co/B2Wa8sOFTp
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
Late-Breaking Abstract L07
The CLASS Project introduces new global classification criteria for Anti-Synthetase Syndrome (ASSD). Using the gold standard dataset, the key findings were:
âś… Definite ASSD: Sensitivity 94.3%, Specificity 99.7%
✅ Probable ASSD: Sensitivity 97.5%,… https://t.co/PtciIMTSsu https://t.co/jvJv2VNvHx
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Late-Breaking Abstract L07
The CLASS Project introduces new global classification criteria for Anti-Synthetase Syndrome (ASSD). Using the gold standard dataset, the key findings were:
âś… Definite ASSD: Sensitivity 94.3%, Specificity 99.7%
✅ Probable ASSD: Sensitivity 97.5%,… https://t.co/PtciIMTSsu https://t.co/jvJv2VNvHx
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Risks for HCQ cardiotoxicity:
👉>5 yrs use
👉>5 mg/kg/d (cumulative dose >500,000 mg)
👉CKD
👉use NSAID
👉preexisting heart dz
👉presence of ocular, derm, SkM toxicity
- Dr M Garschik #ACR24 @rheumnow https://t.co/LFobgls4jm
TheDaoIndex KDAO2011 ( View Tweet)
#2259 💊 Anti-Obesity Meds in RA 📊 152 RA patients on semaglutide/tirzepatide 🔑 Findings 💥Significant ⬇️weight, BMI, ESR, CRP, lipids, pain VAS 💥Improved CVD risk ⛔ 15% GI side effects, 27% discontinued 🔎Study of impact on RA outcomes needed #ACR24 @RheumNow #ACRBest https://t.co/6LCTZl5173
Caoilfhionn Connolly CaoilfhionnMD ( View Tweet)
Dr. @karen_kc123 discusses the results of the VITAL study.
- Long term use of Vit D3 2000IU was safe and decreased the incidence of all autoimmune dses by 22%.
- It took a while to work but the effect dissipates once discontinued.
@RheumNow #ACR24
@rheumarhyme https://t.co/mnwRsdZ06N
sheila RHEUMarampa ( View Tweet)
A#2532
Pre-existing AID for immunoRx?
Excluded from trials
4 prior studies showed no diff in mortality w AID
Propensity-matched cohort study
Followed median 250 days
Hazard ratio: 1.07 (unmatched), 0.97 (matched) - no diff. Mortality about 40% in grps
@RheumNow #ACR24 https://t.co/zyVCPts6s6
Eric Dein ericdeinmd ( View Tweet)
Gottenberg et al. A positive RCT in pSS! DAHLIAS study. Phase 2. 163 patients. Nipocalimab, anti-neonatal Fc receptor (FcRn) mAb. @RheumNow #ACR24 Abstr#2527 https://t.co/M7li4ZoKeY https://t.co/gV9MGnswdR
Richard Conway RichardPAConway ( View Tweet)
Gottenberg et al. A positive RCT in pSS! DAHLIAS study. Phase 2. 163 patients. Nipocalimab, anti-neonatal Fc receptor (FcRn) mAb. @RheumNow #ACR24 Abstr#2527 https://t.co/M7li4ZoKeY https://t.co/gV9MGnswdR
Richard Conway RichardPAConway ( View Tweet)
A#2527 DAHLIAS, P2 Nipocalimab: Anti-FcRn Ab in Ro+ SjD IV 5 or 15 mg/kg Prim Endpt: 15 mg/kg has ClinESSDAI at w24 -6.4 v -3.7 PBO p=0.002 Improv dryness, fatigue, pain Better unstim salivary flow Best response in higher Ab titer pts Safety data good #ACRBest #ACR24 @RheumNow https://t.co/O7zahPul66
Eric Dein ericdeinmd ( View Tweet)
Fertility in RA. Improved outcomes in the T2T group. Abstr#1647 @RheumNow #ACR24 https://t.co/gLpY8enaEb
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Shifting Trends in Initial RA Treatment Approaches
A recent study by Sparks et al (Abstract #0509) reveals evolving trends in disease-modifying antirheumatic drug (DMARD) usage for rheumatoid arthritis (RA) over two decades in the U.S.
https://t.co/6FN0WayZZR #ACR24 https://t.co/dc3CiNpKmx
Dr. John Cush RheumNow ( View Tweet)
Nice data from the OTIS Autoimmune Disease in Pregnancy Project re: certolizumab-exposed pregnancies:
- spontaneous loss rate comparable to non-disease controls
- no stillbirths
- preterm similar to disease controls
Plenty positive for CZP in pregnancy!
#ACR24 ABST0805 @RheumNow https://t.co/XCRYsioxC0
David Liew drdavidliew ( View Tweet)
A study exploring the benefits of treating RA patients to remission after achieving low disease activity (LDA).
Key findings:
- Among patients initially at LDA, achieving remission (CDAI ≤2.8) led to significantly better functional outcomes and reduced durable medical equipment… https://t.co/SNPKlRieur https://t.co/YIQNMf3Oap
Antoni Chan MD (Prof) synovialjoints ( View Tweet)