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RheumNow Podcast - ACR 2021 Rehash (the good stuff..)
The ACR 2021 meeting has concluded. Dr. Jack Cush recounts a few more great abstracts from this past week’s virtual meeting.
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Emapalumab for the treatment of macrophage activation syndrome
Macrophage activation syndrome (MAS) is a term commonly used by rheumatologists to describe a potentially life-threatening complication of systemic inflammatory disorders, most commonly occurring in people with systemic juvenile idiopathic arthritis (sJIA) and systemic lupus erythematosus (SLE).
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ACR21 Best Abstracts We Saw - Day 3 (Monday)
The third day of ACR 2021 took a big leap in online content. Here is a compilation (with links) of presentations were the “ACRBest” as seen by our RheumNow faculty.
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Another study linking long term GC and CV risk in RA!
Medicare data >65yo 130000+ pts
1-year incidence CV ⬆️ as follows:
📍Dose ≤5mg 1.4%
📍Dose 5-10mg 1.7%
📍Dose >10mg 1.9%
Not replicated in younger pts (Optum data)
#ACR21 #Abst1915 @RheumNow https://t.co/DLXdfvfiBW
Aurelie Najm AurelieRheumo ( View Tweet)
Once again #steroids are bad in #RheumatoidArthritis from 2 large admin databases in age >65 in Medicare data, not in younger pts -Optum data. Clear dose response #ACR21 #ACRBest @RheumNow abst#1915 https://t.co/XL93jty7C9
Janet Pope Janetbirdope ( View Tweet)
#ACR21 Abs#1915
👉🏼Chronic steroid use in older adults on stable DMARD therapy
assoc w/ ⬆️CV risk
👉🏼Risk even present among older adults receiving low dose ≤5mg/day
👉🏼Larger studies needed in younger healthier adults
@RheumNow https://t.co/Lsj5YBz7IG
Mrinalini Dey DrMiniDey ( View Tweet)
Long-term low dose glucocorticoid use associated ⬆️cardiovascular risk. Clear effect in Medicare population (older), not evident in Optum (younger). Dose dependent. Abstr#1915 #ACR21 @RheumNow https://t.co/oFet3Hhsfo
Richard Conway RichardPAConway ( View Tweet)
Fibromyalgianess Glucocorticoid Persistence in RA Patients: Dr. Sheila Reyes ( @RHEUMarampa) discusses abstract #0120 presented at the #ACR21 annual meeting.
https://t.co/9yOM5rSARv https://t.co/Gq2YxbxkmM
Links:
Dr. John Cush RheumNow ( View Tweet)
Glory to GLORIA trial? Low dose prednisone 2mg in active RA>65yrs, N=451 All Standard care. in 2yrs, ~40% drop out- same in each grp Better RA control but NNH 9.5 w steroids, mostly non severe infections. So, prednisone debate in RA continues #ACR21 @RheumNow #ACRBest abst#1678 https://t.co/emOaYSjYAa
Janet Pope Janetbirdope ( View Tweet)
Sub-analysis of ICHIBAN study looking at adverse events in tocilizumab treated patients with/without steroids. Steroids associated with small increase in adverse events across board. Abstr#1693 #ACR21 @RheumNow https://t.co/ldiovirKpo
Richard Conway RichardPAConway ( View Tweet)
What is the effect of long-term #steroid use on major adverse #cardiovascular events (MACE)?
Find out in my video summary of abstract #1428 which was presented yesterday by @BethIWallace
Read here👉🏼https://t.co/fCM3m04ruS
Watch here👉🏼https://t.co/TLerQT7XnG
#ACR21 @RheumNow
Links:
Mrinalini Dey DrMiniDey ( View Tweet)
Are there people looking at steroid-sparing therapy as irAE treatment or prevention?
@CCalabreseDO: are there ever
#ACR21 irAE Study Group @RheumNow
(also @NAbdelwahabMD @ReidMDMPH on stage) https://t.co/CLmNaLB68O
David Liew drdavidliew ( View Tweet)
Dr. Furie thinks that pulse IV steroids are more effective than oral high dose steroids. If you use pulse IV, you can then use a lower oral dose of prednisone w/faster taper. Will he mandate pulse IV steroids w/his next trial? ...long pause.. No. #ACR21 @rheumnow
TheDaoIndex KDAO2011 ( View Tweet)
#PJP prophylaxis debate at #lupus hub if on #prednisone + immune suppression. #SLE has ⤴️septra side effects. Don’t know right answer. NNT v NNH is unknown. I don’t use it in #SLE. @RheumNow #ACR21 8M212
Janet Pope Janetbirdope ( View Tweet)
#ILD in #rheumatic diseases. When to use #glucocorticoids and immune suppressive sand anti fibrotic. V clear but harder in real world! @RheumNow #ACR21 #ACRBest https://t.co/R4V5ZggRsu
Janet Pope Janetbirdope ( View Tweet)
Steroids can cause co-morbidities which increase CV risk, but can PNL directly increase CV event (MACE) risk in RA?
30d PNL➡️15% increase in MACE in next 30d
(independent of underlying CV risk, RA dx activity)
PNL actively confers risk!
@BethIWallace #ACR21 ABST1428 @RheumNow https://t.co/cuL69n7cx3
David Liew drdavidliew ( View Tweet)
Plenary Abs#1428 #ACR21
👉🏼Long-term #steroid use is common in RA incl in pts with high risk of #MACE
👉🏼30days of steroids ➡️ 15% increased odds of MACE
@RheumNow
https://t.co/fCM3m04ruS https://t.co/FWGmAatYu5
Mrinalini Dey DrMiniDey ( View Tweet)
26K Veterans data with RA #ACR21 plenary abst#1428
30 days on glucocorticoids - ⬆️15% odds of Major Adverse Cardiovascular events @RheumNow @BethIWallace https://t.co/BOram4o2rp
Bella Mehta bella_mehta ( View Tweet)
Role of GC on MACE in RA:
US database analysis 26000+pts
23% on GC >90d/6mo
Each 30days of GC dispensed ⏭15% increase in odds of MACE in the following 6month period!
Adjustment on several confounders but not disease activity.
#Abts1428 #ACR21 @RheumNow https://t.co/prdA7D5fLz https://t.co/F3wCcRAfuf
Aurelie Najm AurelieRheumo ( View Tweet)
Fautrel describes a series of 13 #AOSD (Stills) pts with Pulmonary arterial HTN (cath confirmed) - seen exclusively with women, 85% and all were on DMARDs - 31% MTX, 69% IL-1i, all on steroids- 5 deaths, 3 yr Survival 74% (same as PAH) #ACR21 Abstract 1100 https://t.co/qR21MdYG3A https://t.co/WN38ifgtT6
Links:
Dr. John Cush RheumNow ( View Tweet)
