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Day 2 Report - ACR Plenaries: Changing the Practice of Rheumatology

d Kathryn H. Dao, M.D.

Over the years of navigating the annual meeting, I found the sessions with the most impact to my practice were the Plenary Sessions. During these sessions, the latest research is presented, new ideas are floated, and old myths debunked. Here are the top ACR2023 Plenary abstracts I found impactful for my practice.

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ARTIC REWIND RCT 3 yrs csDMARD withdrawal 38% 3yrs csDMARDs free remission vs. 80% stable dose gpe 75% recovery after restart Rx progression 19% in half dose gpe More use bioDMARDs (18%) & GCs (50%) withdraw gpe Trends towards lower infections @RheumNow #ACR23 #ACRBest https://t.co/jhOINV7LLS
Aurelie Najm  ( View Tweet)
Tapering ABA vs. stable dose ABA in RA No diff in DAS28 remission at 2 years But… Only in patients receiving concomitant MTX Those tapering ABA mono also experience higher functional important Of note: not an RCT @RheumNow #ACR23 ABST2542 https://t.co/yycCDTnRiF
Aurelie Najm  ( View Tweet)
Rheumatologist - pharmacist co-management of MTX initiators @GeisingerHealth Philadelphia Having the dual skill set actually helped with adherence to guidelines vs standard care. Would be great to see how this works with implementation in RA clinics #ACR23 ABST2484 @RheumNow https://t.co/88R1BYzYn5
David Liew drdavidliew ( View Tweet)
Complements & HCQ? (Prof Petri et al) Significant ⬆️ in C3 (p=0.022) & C4 (p=0.003) levels with HCQ whole blood levels >50 ng/mL Increasing blood levels of HCQ significantly assocd w/⬆️prob of achieving normal C4 Improving C3,C4; addtl benefit of HCQ? #ACR23 ABST2327 @RheumNow https://t.co/5ucpXq9ngb
sheila  ( View Tweet)
TM83 #ACR23 @RheumNow 45yo M b/l sacroiliitis, Rx MTX -> ADA -> MTX + Tofa. No improv Low Ca, & Phos, ALP 239. Nml Vit D, High PTH. DEXA: Osteoporosis FGF23 high PET/CT showed soft tissue density in nasal septum, few cortical breaks Dx: oncogenic osteomalacia 2/2 malignancy https://t.co/EOcYNtovBy
Eric Dein  ( View Tweet)
Extended-Release Fluticasone Propionate for Injectable Suspension - EP-104IAR Phase 2 Randomized (1:1), Double-blind, Vehicle-Controlled Trial 318 pts, 57% F, age 64, Clinically and statistically significant pain relief for 14 weeks compared to vehicle @RheumNow #ACR23 #abstL04

Bella Mehta bella_mehta ( View Tweet)

If we're to summarize the challenges to making for CAR-T therapy work in a given disease, this is it: Dr. Chyi-Song Hsieh ⁦@WUSTL #ACR23 @RheumNow https://t.co/raoHtrJ25S
David Liew drdavidliew ( View Tweet)
Great summary of the big takeaways yesterday at #ACR23. Always love talking to @KDAO2011 @EBRheum @RheumNow We get into the use of MTX, the safety on TNFs and what is in the purview of rheumatology practice https://t.co/jm0a8ndrsi

Eric Dein  ( View Tweet)

Read my article on ACR Plenaries: Changing the Practice of Rheumatology #ACR23 @ACRheum @RheumNow @uptoTate @Yuz6Yusof @ericdeinmd https://t.co/ql851dVzAk

TheDaoIndex KDAO2011 ( View Tweet)

1-PJP prophylaxis or not in ANCA? 2-MTX single dose or split dose? 3-IL6 blocker early on in GCA/PMR? 4-SGLT2 in DM/Lupus nephritis? 5-Cervical cancer screening in Lupus? 6-TNF induced ILD? https://t.co/mzGXajmQqE @RheumNow , Daily recap #ACR23

Nouf Al hemmadi  ( View Tweet)

ACR Best

#ACRbest Abstracts – Day 2

d Jack Cush, MD

Our reporters have been prolific in finding the hot abstracts, those that were most attended or those that are getting the most buzz on social media.  Here are RheumNow's #ACRbest abstract reports from Monday, November 13, 2023 at #ACR23, covering The Great Debate, SGLPT2 inhibitors in SLE, the SMART Study of MTX, TMP/SMX Prophylaxis, RA-ILD & TNF Inhibitors, cancer research and more. 

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am pm pillbox containing pills in each slot

Methotrexate: shall we split up?

d Aurelie Najm, MD, PhD

Methotrexate is widely used in rheumatic diseases yet poses common tolerance issues, especially for the oral form; and bioavailability is known to be limited for doses over 15mg. In the SMART study, Prasad et al. present the first RCT comparing either single dose (25 mg) or split-dose (10 mg morning, 15 mg evening, same day) once weekly MTX for 24 weeks.

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2 RA cohorts w/Breast Cancer 17% TNFi within 1yr after surgery No diff in overall survival at 5 yr w/ TNFi or csDMARD Trend towards better BC specific survival w/ TNFi vs. csDMARD only Worst survival for GC>7.5mg/day Only 2 yrs follow up @RheumNow #ACR23 ABST1675 https://t.co/ekKlJ2dP5i
Aurelie Najm  ( View Tweet)
Does TNFi use in pts with RA and early breast cancer affect survival? TNFi did not affect overall survival or breast cancer specific survival compared to cDMARDs Steroids did increase mortality @RheumNow #ACR23 Abs#1675

Robert B Chao, MD  ( View Tweet)

No significant difference in overall survival in early stage breast cancer (BC) patients treated with TNFi (alone -/+ cDMARDs, in 1st year of BC) and cDMARDs in RA. Those on glucocorticoids had worse survival. Suarez-Almazor M, Abst#1675 #ACR23 @RheumNow https://t.co/lnZx3OpuN5

Dr. Antoni Chan  ( View Tweet)

Two-week interruption of MTX for IMIDs enhanced boost of antibody responses after COVID-19 vaccination, sustained at 12, 26 weeks. Consistent across ages, MTX doses, route, IMIDs, primary vaccination platform,COVID-19, Abhishek A Abst#1677 #ACR23 @RheumNow https://t.co/T0KdsGh6vg

Dr. Antoni Chan  ( View Tweet)

VROOM 🏎️ study 2 wks interruption of MTX just after COVID vaccine: -Increase S1-RBD Ab response for 26 wks -Improves Neutralizing Ab titres (Wuhan Hu-1) -Leads to more flares wks 4 & 12 Greater effect when MTX dose>15mg @RheumNow #ACR23 ABST1677 https://t.co/SJmaRHtbRH
Aurelie Najm  ( View Tweet)
Abishek et al. 2 week break from MTX enhances response to COVID-19 vaccination, mirroring what we saw for flu. Trade off is short term worsening of disease activity. Abstr#1677 #ACR23 @RheumNow https://t.co/gguRWER81x https://t.co/1hncvDTahH
Richard Conway  ( View Tweet)
Abst#1583 SMART study: Split dose qwk MTX (10 mg QAM, 15 mg QPM) may have better efficacy compared to 25 mg single dose qwk MTX. RCT 253 RA patients: split dose had better DAS score, less likely to add other DMARDS, but slight⬆️in LFTs. #Plenary #ACR23 @rheumnow #ACRbest

TheDaoIndex KDAO2011 ( View Tweet)

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