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Playing it Safe with RA? JAK vs. TNF Debate
Reported safety signals, at odds with the efficacy of these medications, have left rheumatology clinicians in a difficult position when considering when during a patient’s treatment course and in which patients, specifically, JAKi should be used. Two abstracts from ACR convergence 2024 further contribute to our understanding of this potential risk profile.
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Lacaille et al. Long term harms of previous steroids in RA. CV/infection mortality increase 7% every year/use. Takes 3.5 and 10 years to return to normal after 1 and 2 years use. Never returns to normal if >2 years use @RheumNow #ACR24 Abstr#2673 #ACRbest https://t.co/qcp5mCHmeB https://t.co/keXw5Qg2ld
Richard Conway RichardPAConway ( View Tweet)
Lacaille et al. Long term harms of previous steroids in RA. CV/infection mortality increase 7% every year/use. Takes 3.5 and 10 years to return to normal after 1 and 2 years use. Never returns to normal if >2 years use @RheumNow #ACR24 Abstr#2673 #ACRbest https://t.co/qcp5mCHmeB https://t.co/keXw5Qg2ld
Richard Conway RichardPAConway ( View Tweet)
All-caps abstract text throw-down by Michelle Petri re:fractures in SLE 😆
I keep saying this; our obsesssion with vitamin d is not commensurate w/reality
It's. The. Prednisone.
#ACR24 @RheumNow Abstr#2679 #ACRBest https://t.co/13luByNvYT
Mike Putman EBRheum ( View Tweet)
Does CVD mortality risk change after stopping GC in RA?
➡️28078 incident GC users
➡️Incr mortality risk from CVD &infections persists post-cessation
➡️Risk never returns to pre-GC level after prolonged use
⏩Use GC at lowest dose for shortest time possible
Ab2673 #ACR24 @Rheumnow https://t.co/dtLU8obLke
Mrinalini Dey DrMiniDey ( View Tweet)
Increased risk of mortality related to negative effects of GC use persists long after stopping and never return to pre-GC levels. #GCStewardship
#ACR24 @RheumNow ABST#2673 https://t.co/5AwHDmvQGf
Jiha Lee JihaRheum ( View Tweet)
Ab2674 #ACR24
➡️Most pts starting 1st-line TNFi, who didn't achieve treatment response at 3M, also didn't achieve response from months 3-12
➡️1/4 pts achieving LDA/remission at 3M were no longer in LDA/remission at 12M
@RheumNow https://t.co/pFOo86tJTx
Mrinalini Dey DrMiniDey ( View Tweet)
Late breaking abstract L17
CAR-NK Therapy for Refractory SLE.
In a trial of 20 severe SLE patients:
- 75% achieved LLDAS, 50% achieved DORIS remission at 6 months
- B cell reconstitution: 2–3 months post-treatment
- Safety: 2 mild cytokine release syndrome with fever; no severe… https://t.co/MS8cutm48o
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
🚨 New SLE treatment update! 🚨 Dapirolizumab pegol (DZP), novel CD40L inhibitor, for moderate-to-severe lupus. Phase 3 trial, DZP reduced disease activity, helped taper steroids, and achieved a higher BICLA Safe and generally well tolerated! #ACR24 #L16 @rheumnow https://t.co/lFrKjz4CZ1
Bella Mehta bella_mehta ( View Tweet)
In this study by Dr CArriens et al, there was no difference between the vaccine response to Influenza by either HAI or Ab levels in Anifrolumab-treated pts.
AEs - mild, moderate
No serious aEs
💉#vaccinate your pts on anifrolumab with influenza
@RheumNow #ACR24 abs2424 https://t.co/XPwlzUS02i
sheila RHEUMarampa ( View Tweet)
Mortality Risk After Stopping Glucocorticosteroids (GC) in RA.
In a study of 28,078 RA patients:
Mortality risk from CVD ↑ 7.5%/year of GC use; ↓ 1.3%/year after stopping.
Mortality risk from infections ↑ 6.8%/year of GC use; ↓ 4.9%/year after stopping.
Risks normalize 1.5–10… https://t.co/i6cKet1EEV https://t.co/ClMjIly20E
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Mortality Risk After Stopping Glucocorticosteroids (GC) in RA.
In a study of 28,078 RA patients:
Mortality risk from CVD ↑ 7.5%/year of GC use; ↓ 1.3%/year after stopping.
Mortality risk from infections ↑ 6.8%/year of GC use; ↓ 4.9%/year after stopping.
Risks normalize 1.5–10… https://t.co/i6cKet1EEV https://t.co/ClMjIly20E
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
VACIMRA Study showed timing matters for Methotrexate and Pneumococcal Vaccine in RA.
RA patients vaccinated with PCV13 1 month before MTX initiation had higher responder rates at 1 month:
88% (ELISA) vs. 75%
96% (OPA) vs. 88%
At 12 months, responses remained stronger in… https://t.co/bSbIazsRtG
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Hydralazine - known culprit of drug-induced AAV
How does hydral (H) AAV differ from primary (1) AAV?
💥 High dual positivity MPO/PR3
💥 DAH / pleuritis more common in H-AAV
💥 ENT, constitutional, nervous, ILD in 1-AAV
💥 More 6mo remission in H-AAV
@rheumnow #ACR24 Abst 2496
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
Severe thrombocytopenia (TP) is rare but linked to major organ involvement and poor prognosis in #SLE. Data from the RISE registry shows TP in 9.3% of SLE patients, with higher prevalence in males, African-Americans+ those with multiple comorbidities.
#ACR24 @RheumNow abst#2680
Bella Mehta bella_mehta ( View Tweet)
In prelim analysis of this controlled clinical trial, SLE pts w/ active dse who weres given addtl NAC for 3 mos had significantly reduced dse activity.
Mechanism? NAC reduces rapamycin (mTOR) activation.
Common AEs: nausea, vomiting
@RheumNow #ACR24 abs2677 https://t.co/E4w2Qd7RwP
sheila RHEUMarampa ( View Tweet)
LEVI-04 a novel neurotropin3-i showed:
-significant analgesia across all measures
-improvement in functional measures and PGA for all doses in a Ph2 RCT
- well tolerated
Hopefully will prove to be a therapeutic option for knee #osteoarthritis in future
@RheumNow #ACR24 absL15 https://t.co/kWsyyyGxyU
sheila RHEUMarampa ( View Tweet)
PHOENYCS GO, RCT of dapirplizumab, novel CD40Li in SLE
Met primary endpoint (NNT~6 for BICLA) & numerical improvements in many other endpts
1 MI & 1 death from infection over 213 pts
Encouraging for sure! Second phase 3 being launched
#ACR24 @RheumNow Abstr#L16 #ACRbest https://t.co/QwDMKjhFvb
Mike Putman EBRheum ( View Tweet)
#MDA5 #dermatomyositis assoc #ILD
May do better w
#tofacitinib vs #CNI in 515 pts
Too bad they didn’t do a pragmatic RCT as we do t know the reasons for prescribing each #Rx
But impressive survival w #tofa
#ACR24 @ACRheum @RheumNow abst1736 https://t.co/HLJknSYcNJ
Janet Pope Janetbirdope ( View Tweet)
Lot said about #ACR24 ABST1697:
MTX in newly diagnosed PMR, neg RCT
Many have said no hope for MTX in PMR now
Agree doesn't bode well
However, MTX may still have role in established PMR
@drceowen & I have made that call a priori @TheLancetRheum https://t.co/ywCJc0zHzC
@RheumNow https://t.co/JUXk2tDNyR
David Liew drdavidliew ( View Tweet)