All News
Monitoring Infliximab Drug Levels Improves Efficacy
Should we start considering therapeutic drug monitoring when prescribing TNFi for treatment of our rheumatologic conditions?
Read Article
Drug retention of TNFi vs. secukinumab in AxSpA pts
Abs#911
⭐️46% discontinued either treatment
⭐️TNFi with slightly better drug retention
⭐️Age, BASDAI, BMI did not favor any group
⭐️inefficacy - main reason
#ACR21 @RheumNow https://t.co/ynoomYrTvX
Robert B Chao, MD doctorRBC ( View Tweet)
⭐️Prevalent drug utilization was not related to enthesitis activity
⭐️Prevalent use of cDMARDs 🔼physician GAS compared to TNFi/IL-17i
⭐️No correlation in disease activity scores amongst the use of different prevalent PsA drug Rx
Abst# 1782 #ACR21 @RheumNow @doctorRBC https://t.co/uzmTP1hZ2P
swethaann23 swethaann23 ( View Tweet)
Dose Tapering of TNFi in AxSpA: Dr. Antoni Chan ( @synovialjoints) discusses abstract #0364 presented at the #ACR21 annual meeting.
https://t.co/pDnKFfeQdP https://t.co/7CZg2lkSFI
Links:
Dr. John Cush RheumNow ( View Tweet)
Put those two RF together (essentially nailing down RA pts at risk of cancer):
age >65 or ever smoked, all tofa vs TNFi: HR 1.55 (1.05-2.30)
age >65 or ever smoked, tofa 5 bid vs TNFi: HR 1.44 (0.93-2.24)
neither RF, all tofa vs TNFi: HR 1.16 (0.53-2.55)
#ACR21 @RheumNow https://t.co/Uvr4wBhFVF
David Liew drdavidliew ( View Tweet)
Therapeutic drug monitoring ⬆️ infliximab efficacy in RCT. 17.6% improvement in sustained disease control. Consistent across all rheumatic and non-rheumatic diseases. Abstr#1946 #ACR21 @RheumNow https://t.co/D1Ppb58fB8
Richard Conway RichardPAConway ( View Tweet)
ORAL Surveillance malignancy risk @RADoctor . Numerically higher at both doses tofacitinib compared to TNFi . Abstr#1940 #ACR21 @RheumNow https://t.co/uc2k5EaiRq
Richard Conway RichardPAConway ( View Tweet)
ORAL Surveillance: MACE and malignancy are getting all the attention...
but did you know that non-zoster infections are also more likely with tofacitinib vs TNFis?
#ACR21 ABST1684 @RheumNow https://t.co/GiBkvPYs4j
David Liew drdavidliew ( View Tweet)
Serious infections beyond herpes zoster in both doses of #tofacitinib v #TNFi in Oral Surveillance. Note this outcome was not powered to be stat sig. it is a comparison of SIE events #ACR21 abst#1684 @RheumNow https://t.co/uqME6ABXuC
Janet Pope Janetbirdope ( View Tweet)
Canadian study found no significant differences in effectiveness or tx survival among different TNFi, or in nr-axSpA or AS. Failure of 1st TNFi didn't diminish effectiveness or drug survival of additional TNFi. Abs 0938 #ACR21 #RheumNow @RheumNow https://t.co/u1efnfv2zA https://t.co/qsJw3nA9qn
Dr. Rachel Tate uptoTate ( View Tweet)
Abst1830 #ACR21 @RheumNow d/c of TNFi in PsA/PSO: probability of d/c TNFi ⬆️ by 9.6% for each additional biologic trial. Former smoker &PsA duration correlated w/ discontinuation. most commonly reason for d/c TNFi was secondary failure (33%). infliximab had lower d/c rate https://t.co/BXd2ALX2qo
Olga Petryna DrPetryna ( View Tweet)
Prevalent drug utilization unrelated to enthesitis in PsA. Pts on cDMARDs had higher physician globals vs those treated w/TNFi & IL-17i. In aggregate, no pattern of dz activity scores correlation w/drugs. Abs 1782 #ACR21 #RheumNow @RheumNow @doctorRBC https://t.co/x57BkBjpjo https://t.co/QmdXqOxLki
Dr. Rachel Tate uptoTate ( View Tweet)
After 2018 ACR Guidelines, significant increase in IL-17i and PDE4i use in PsA pts
⭐️TNFi most common tx
⭐️28% pts not on any tx⭐️
#ACR21 @RheumNow Abs#1810
https://t.co/7Rmirfm3nK https://t.co/0Ui9pq5uyo
Links:
Robert B Chao, MD doctorRBC ( View Tweet)
Just worthwhile remembering:
in terms of TNFi anti-drug immunogenicity in autoimmune disease:
RA is top of the pops
(although dose spacing is worse)
data from NOR-DRUM A, TDM in infliximab #ACR21 ABST1525 @RheumNow https://t.co/wfcA72wcLP https://t.co/mHppH6qYdY
David Liew drdavidliew ( View Tweet)
No clear excess risk for offspring exposed in-utero to, VED or TNFi's. UST showed infection signal BUT w/ wide CIs. We need more research re: biologics and placental transmission potential/subsequent risks. Abs 1713 #ACR21 #RheumNow #ACRbest @RheumNow https://t.co/W3K5uDyHlC
Dr. Rachel Tate uptoTate ( View Tweet)
No significant difference in enthesitis activity in PsA pts taking csDMARD vs. TNFi vs. IL-17i
⭐️Age, duration of disease, physician global were main differences in TNFi and IL-17i vs. cDMARD
⭐️no specific clustering noted
Abs#1782
#ACR21 @RheumNow
https://t.co/AH33ZjHUa1 https://t.co/Gb2zKMBUqo
Links:
Robert B Chao, MD doctorRBC ( View Tweet)
Phase 2 Placebo/Deucravacitinib 6mg/12mg od study ACR20 at 16 weeks of 31.8%/52.9%/62.7% respectively. Efficacy observed across TNFi and body weight subgroups. Safety profile similar to Phase 3 trials in patients with psoriasis @RheumNow #ACR21 Abst#1820 https://t.co/bOfEZdqN5Z https://t.co/EjMwWISM80
Dr. Antoni Chan synovialjoints ( View Tweet)
Avoid IFX drug holidays!
In this study 400+ pts
Dvlpmt of ADAs associated w/
▶️RA vs. SPA OR 2.1
▶️Smoking OR 1.8
▶️Drug holidays > 11 weeks OR 4.1
▶️High DA OR 1.5
while
◀️Concomitant IS drug OR 0.4
◀️ IFX dose increments OR 0.4, were protective #ACR21 @RheumNow #Abst1525 https://t.co/cxx7aWX5wh
Aurelie Najm AurelieRheumo ( View Tweet)
Upadacitinib 56-wk efficacy/safety (mod to severe PsA)
🔹Comparable or ⬆️efficacy vs adalimumab
🔹Efficacy maintained, and 15mg vs 30mg doses similar at 56wks
🔹No new safety findings @ 56wks
🔹🚫inc risk VTE, MACE, cancer vs ada
https://t.co/NlKvBrwDxB
#ACR21 Abst#1345 @RheumNow
Pedro Castillo _Castillo_Pedro ( View Tweet)
#ACR21 @RheumNow
Abst#0364 by Wetterslev et al. sought to identify axSpA characteristics of patients tapered off TNFI and showed clinical and radiographic improvement.
🔽52% were tapered off
⭐️The highest predictor of success is a low physician global VAS score
swethaann23 swethaann23 ( View Tweet)