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Cognitive Impairment: The Hidden Burden in Lupus Care
Suppose you have a patient with lupus returning for follow-up. Their joint symptoms are well controlled. The kidneys—managed with a combination of biologic DMARD and mycophenolate—show no signs of active urinary sediment or protein. Yet, during the routine visit, your patient brings up fatigue and difficulty remembering things. How do you address this? Several studies presented at ACR24 focused on cognitive impairment in lupus.
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ACR 2024 - Day 3 Report
Highlights from Day 3 at ACR24 included the plenary session presentation on Nipocalimab (previously reviewed), but the big highlight was the Lupus Nephritis guideline recommendations.
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Abstract 2681: #SDOH factors & SLE risk:
- Low income (AOR=2.779).
- By race/ethnicity NHB (AOR=2.429), Hispanic (AOR=1.616).
Behavioral: Psych distress (AOR=2.127), no exercise (AOR=1.677).
Access: Medicaid (AOR=2.540), transport barriers (AOR=20.394).
@RheumNow #ACR24
Akhil Sood MD AkhilSoodMD ( View Tweet)
#Ianalumab
300 mg sc q monthly
B cell depleted and changes BAFF signalling
👇⬇️IFN
May be promising in #lupus #SLE
+data in primary #Sjogrens
ACR24 @RheumNow @ACRheum
Abst#2425
Needs Phase3
➡️I suspect safer than CAR T and Bispecific T cell engagers but
? ⬇️efficacy
Janet Pope Janetbirdope ( View Tweet)
Prior studies have shown that IFN is increased in non-lesional skin of SLE pts.
In this study, they found a ⬆️ expression of IFN stimulated genes (ISGs) in pts w/ a history of CLE.
No correlation w/ CLASI act & IFN scores but only few pts.
@RheumNow #ACR24 abs2678 https://t.co/cPT6yPkoCb
Links:
sheila RHEUMarampa ( View Tweet)
Prof Petri reports the ff predictors of fracture in SLE:
-older age
-Caucasian race
-female sex
⚠️ Prednisone (but not recent IM triamcinolone or IV methylpred) is a MAJOR risk factor.
When possible, avoid prednisone!
@RheumNow #ACR24 #ACRbest abs2679
@rheumarhyme https://t.co/q2NMRaYsAF
Links:
sheila RHEUMarampa ( 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
Links:
Mike Putman EBRheum ( View Tweet)
What are the predictors of fracture in #SLE?
🦴Prednisone! Even at low doses ≤5mg
🦴Stroke
🦴Caucasian race
🦴Female
🦴Low BMD
Try to avoid steroid use. If they are needed, IM triamcinolone or IVMP preferable to oral GC.
Ab2679 #ACR24 @RheumNow
Mrinalini Dey DrMiniDey ( View Tweet)
Data from the RISE registry show that 9.3% of SLE pts had thrombocytopenia and a smaller percentage with mod-severe TP (2.7%). Severe TP was much rare.
Large data, but well represented grp?
@RheumNow #ACR24 abs2680 https://t.co/Y1Lo9lJGtO
Links:
sheila RHEUMarampa ( 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)
In Vivo CAR T Cell Therapy.
A single intralymphatic injection of VivoVec™ particles:
- Generates functional CAR T cells in vivo
- Achieves complete B cell depletion in NHPs without lymphodepletion
- Demonstrates potential for an off-the-shelf solution for autoimmune disease… https://t.co/5DTzRvZjbY https://t.co/DvTOqnhn1V
Links:
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)
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
Links:
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
Links:
Mike Putman EBRheum ( View Tweet)
It is NO LONGER a ACCEPTABLE
To NOT consider
#MMF or #Cyclo + another proven #Rx
Added to
#HCQ and #tapering /limiting #glucocorticoids
RCTs in #lupus #nephritis support this
? Is which to add
#belimumab
#CNI #volclosporin
#obinutuzimab
#ACR #ACRbest @RheumNow @ACRheum https://t.co/a7WMFfCyXl
Janet Pope Janetbirdope ( View Tweet)
Pathophysiological pathways in neuropsychiatric SLE. 2 components:
-Ischaemic
-Inflammatory
Zahi Touma @RheumNow #ACR24 https://t.co/wwlSSSpOIU
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Subsets of lupus arthritis. Kenneth Kalunian @RheumNow #ACR24 https://t.co/ZmHui126zr
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Study by Maria Dall'Era et al. compared voclosporin-based triple immunosuppressive therapy with high-dose GC in active lupus nephritis.
- Fewer adverse events in the voclosporin group, despite a higher incidence of specific issues like decreased GFR and hypertension.
- 25%… https://t.co/ToRu2rdErC https://t.co/uUXzNNuLDb
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Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Loiseau et al. 4700 pSS, 47000 comparators. pSS associated with increased risk of every CV/VTE outcome. Did not have that in my priors! @RheumNow #ACR24 Abstr#2631 https://t.co/QKemUhbcG8 https://t.co/twpjdS2L63
Links:
Richard Conway RichardPAConway ( View Tweet)
