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Cohort study comparing 3yr safety outcomes of JAKi vs. TNFi in AS pts
JAKi use: ⬆️incidence of HZ infxn but not significant; ⬆️all-cause mortality (HR 4.94) and GI bleed (p=0.04)
Individualize tx. consider potential complications
#ACR25 @RheumNow Abs2633 https://t.co/pjKAazQFwW
Links:
sheila RHEUMarampa ( View Tweet)
Lung Disease in ANCA-associated Vasculitis
Dr. Mike Putman discusses abstract 0721, "Pulmonary Manifestations of Granulomatosis with Polyangiitis and Microscopic Polyangiitis", presented at #ACR25.
https://t.co/A5uKT4jG1I https://t.co/7E4k7QdiNK
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Dr. John Cush RheumNow ( View Tweet)
In a retrospective TrinetX analysis of 3 year safety outcome in AS, JAKi use was linked to higher mortality and GI bleeding vs TNFi, but lower malignancy risk. Infection rates were similar, with a trend toward more herpes zoster in JAKi users. Abstract#2633 @RheumNow #ACR25 https://t.co/pPY0wpAKA3
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Adverse events from avacopan the WHO pharmacovigilence database (VigiBase)
Not a lot new - infections happen, hepatic events happen but seem to be somewhat rare
Pharmacovigilence is hard; most events go unreported & we often have the classic "denominator problem" (ie we saw https://t.co/28tYkXv0Lz
Mike Putman EBRheum ( View Tweet)
Infection vs steroid sparing in PMR/GCA/AAV studies with steroid-sparing Rx
GiACTA (1, top right) aside,
- low infection rates
- the more steroid saved, the less the infection risk
Infection risk in vasculitis is driven by steroid, not DMARD
#ACR25 ABST2526 @RheumNow https://t.co/UprbxUQyQC
David Liew drdavidliew ( View Tweet)
#ACR25 How hard will you go & at what cost? A study in China using CD20/BCMA Bispecific autologous CAR-T showed profound depletion, normalisation of abs and good response in #SLE (10/11 had LN). But 2 had G3 infections & cytopenia. Presenters said some had IVIG @RheumNow #ACRBest https://t.co/TF0wpib5rr
Links:
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
#1747 Serious infections ~2× more common in RA-LD, esp RA-ILD. Pulmonary, bacterial, viral & fungal infections all increased, underscoring need for tailored prevention and vaccination. @RheumNow #ACR25 https://t.co/soyzqLk7Vj
Mrinalini Dey DrMiniDey ( View Tweet)
#ACR25 Abstr#LB02 Is there a role for JAK-i for the treatment of IgG4-RD? Opel label RCT in China (N=58) showed NO relapse in Tofacitinib + GC taper vs GC Taper alone (54%). No serious infection. Interesting and a PBO-controlled is warranted @RheumNow https://t.co/dFvAmcGfCT
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
EGPA relapse in MANDARA including OLE
Majority of relapses are asthma / sinonasal in nature
Of non-airway:
- arthralgia/myalgia
- sensory peripheral neuropathy
@RheumNow #ACR25 Abst1769 https://t.co/cPjjzl4RWS
Links:
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
MSK side effects of CAR-T, based on FAERS pharmacovigilance data (also see @DrGomezPuerta in @seminarthrheum https://t.co/LnwjU5aebs) #ACR25 ABST1731 @RheumNow https://t.co/kREEy3HLE9
Links:
David Liew drdavidliew ( View Tweet)
Is RA-ILD associated with/ higher risk of infection?
Retrospective US cohort study
151 RA-ILD
980 matched controls
79% higher risk of any and pulmonary infections in RA-ILD
Pathogen type: bacterial, viral and fungi
Some of these infections are preventable!
Take Home: https://t.co/fPmRjLL7Po
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Aurelie Najm AurelieRheumo ( View Tweet)
Does specific ANCA subtype inform infectious risk?
Retrospective review of 270 AAV patients revealed that about 1/3 pt developed severe infections... of these:
- 64.1% MPO+
- 35.9% PR3+
Most infx during year 1 of tx
No difference between CYC vs. RTX
@RheumNow #ACR25 abst 2510
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
How does DADA2 present?
Ten studies provided data on a total 225 patients
1) skin findings
2) fever
3) stroke
4) cytopenias
@RheumNow #ACR25 Abst 1615 https://t.co/xZuTk6YFdJ
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
Abstract 1718: Immune checkpoint inhibitors (ICI) in pre-existing #SLE
Compared to non-SLE pts, those with SLE receiving ICIs had:
🔹 ↑ risk of thrombocytopenia & pancytopenia
🔹 No significant difference in all-cause mortality
@RheumNow #ACR25 https://t.co/N1iOvxbsAZ
Akhil Sood MD, MS AkhilSoodMD ( View Tweet)
When MAS is suspected. Soluble IL2 receptor alpha and CXCL9 may be useful (however t cell lymphomas and viral infections like hepatitis may also have them)
#ACR25 @RheumNow
Key takeaways below https://t.co/wJv1dvwU88
Bella Mehta bella_mehta ( View Tweet)
Soluble IL2 receptors help assess macrophages behavior. Ferritin also asses the same in Macrophage activation syndrome.
ADA2 is the newer biomarker for hemophagocytic syndromes.
#ACR25 @RheumNow
Interferon gamma also a newer important target in MAS https://t.co/7sWwninBTM
Bella Mehta bella_mehta ( View Tweet)
IL- 18 go together sometimes with glycolytic enzymes such as aldolase
Also MAS may not be a switch on and off mechanism.
Lastly MAS with Stills may have increased IL18 levels but not in other disease like SLE
#ACR25 @RheumNow https://t.co/BW1fD7usBT
Bella Mehta bella_mehta ( View Tweet)
#ACR25 Abstr#1537 Beyond T-cell malignancy, we should be vigilant re: Local immune effector cell-associated toxicity syndrome (LICATS) with CAR-T. - Mostly afect skin & kidneys - Med time of onset 10 days; duration 11 days -Most LICATS were mild & without sequelae @RheumNow https://t.co/EnAWL936oh
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
Dr. Gensler gave a fantastic talk on SpA mimics
☝️Not all IBP is axSpA - interpret in the appropriate context + imaging
WOF other mimics
🔸 Sacral insufficiency fractures
🔸 Infections
🔸DISH
#ACR25 @RheumNow https://t.co/7TIqyp5rYe
Links:
sheila RHEUMarampa ( View Tweet)
In a cohort of 269,304 IBD patients, NSAID use showed a small increase in IBD-related hospitalisation (HR 1.08), meeting non-inferiority threshold (HR <1.2). No risk in UC (HR 0.96); modest risk in Crohn’s (HR 1.16). Relooks at the current paradigm of blanket NSAID avoidance in https://t.co/O8MWg1BP50
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
