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ACR21 Best Abstracts - Day 1
The RheumNow faculty have been glued to their monitors all day, watching video, and running down abstract presentations to find the best – several of these stood out as #ACRBests. Here is a listing of “Best” they saw on Day 1.
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Work participation in patients with axial spondyloarthritis
Patients with axial spondyloarthritis (axSpA) often have increased absence from work as well as reduced productivity at work, which can have profound impacts for not only the affected individual and their families, but also lead to wider economic and social burden.
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The Influence of Obesity on Choice of Biologic Agent in Rheumatoid Arthritis
In rheumatoid arthritis we have a wide range of options available to us when we progress to a biologic treatment option. We have little to differentiate between these agents based on the clinical trials.
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Physician global score was the strongest predictor of future flares in AS patients with TNFi dose tapering. 29 (27%) flared at 2/3 of standard
dose, 21 (20%) at 1/2 dose, 29 (27%) at 1/3 dose and 27 (25%) after discontinuation @RheumNow #ACR21 Abst#0929 https://t.co/pIzLgexe3k https://t.co/UM9cGLiYl7
Dr. Antoni Chan synovialjoints ( View Tweet)
Physician global score only predictor of axSpA flares when tapering TNFi
⭐️Changes in imaging did not predict flare
Abs#929
#ACR21 @RheumNow
https://t.co/vVn6ARKJu0 https://t.co/FlVtlLmTfl
Robert B Chao, MD doctorRBC ( View Tweet)
French real-world AxSpA cohort analysis showed drug retention of SEC & TNFi were similar. In subgroups analyses, age, BASDAI at dx & BMI were similar. Abs 0911 #ACR21 #RheumNow @RheumNow https://t.co/ewtmpxKTNu https://t.co/Yh0nX3x83Z
Dr. Rachel Tate uptoTate ( View Tweet)
#ACR21 Abs#0834: CorEvitas Registry TNFi vs IL-6 in RA
⭐️IL6 pts older, longer h/o RA, higher CDAI, more prior Rx
▶️ No difference in outcomes bw IL6 and TNFi (monotherapy or combo w MTX).
▶️1/3 of pts achieved LDA
Limits: real-world, unblinded
https://t.co/AJtzeMuj1T @Rheumnow
Links:
Eric Dein ericdeinmd ( View Tweet)
Dr Jin @SeoyoungCKim population-based study on predictors of switching after 1st line TNFi use. 22% switch, most to 2nd TNFi.👩, prior steroid use predicted change, other autoimmune disease and vit D use negative predictors. Abstr#579 #ACR21 @RheumNow https://t.co/YpZ5rGBiod
Richard Conway RichardPAConway ( View Tweet)
@MilenaGianfran @JYazdanyMD present on differential effects of biologics on CDAI in obese patients with rheumatoid arthritis. Abatacept better than TNFi in obese. Tocilizumab better than TNFi in non-obese. Abstr#0588 #ACR21 @RheumNow #ACRBest https://t.co/UcEpMAmNVw
Richard Conway RichardPAConway ( View Tweet)
No significant difference in effectiveness/treatment survival of different TNFi in axSpA
Failure of 1st TNFi did not diminish effectiveness of a second TNFi
Abs#938
#ACR21 @RheumNow
https://t.co/SLrOV7wmvU https://t.co/fkpmseVwF6
Robert B Chao, MD doctorRBC ( View Tweet)
Abstr 0579
Kim & Colleagues examined predictors of Tx change among RA patients w/ TNFi as 1st line biologic agent
- Females & GC use more likely to switch agent
- Vitamin D use & hx of other immune-mediated diseases (eg. Psoriasis, IBD) less likely to switch
#ACR21 @RheumNow https://t.co/FM5mSWmSNA
Akhil Sood MD AkhilSoodMD ( View Tweet)
No evidence to show increased risk of incident hypertension w/ TNFi use, after accounting for baseline & time-dependent confounding factors, in prospective AS cohort. Abs 0910 #ACR21 #RheumNow @RheumNow https://t.co/1SpQ51ftlK
Dr. Rachel Tate uptoTate ( View Tweet)
French, real-world axSpA cohort analysis shows SEC and TNFi retention rates similar. What do you see in your practice? Abs 0911 #ACR21 #RheumNow @RheumNow https://t.co/vu3zUwfktl https://t.co/v6DLjWJMn4
Dr. Rachel Tate uptoTate ( View Tweet)
@rheum_cat presenting a really well designed study looking at association between TNFi use and incident hypertension in axSpA. No association found. Abstr#0910 #ACR21 @RheumNow https://t.co/w7o1oDreVL
Richard Conway RichardPAConway ( View Tweet)
And here is ORAL-Surveillance, small increase in MACE and malignancy with tofacitinib vs TNFi. 1 extra MACE per 319-567 patient years, 1 extra malignancy per 275 patient years. Abstr#0831 #ACR21 @RheumNow https://t.co/wMJnspTTBy
Richard Conway RichardPAConway ( View Tweet)
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)
So it's day 2 at #ACR21, and you know what that means - it's ORAL Surveillance day!
This is the figure everyone will be talking about, leading up to details in the plenary.
Why are the other bars higher than the pink bars?
ABST0831
plenty of @RheumNow coverage coming on this https://t.co/B80cSmhNV7
David Liew drdavidliew ( View Tweet)
ORAL Surveillance
In mod-severe RA pts >50yo, with CV RF & no hx malignancy, patient-years of exposure required for one event (vs TNFi):
MACE
tofa 5mg bid: 567
tofa 10mg bid: 319
malignancy
tofa 5mg bid: 276
tofa 10mg bid: 275
#ACR21 ABST0831 @RheumNow https://t.co/9vyXPTMFzj
David Liew drdavidliew ( View Tweet)
ADACTA & MONARCH both showed IL6i monoRx > TNFi monoRx for RA in DBRCTs.
What about in real-world data?
Looking at CorEvitas, less so
LDA: aOR 0.99
MCID in CDAI: 1.06
Even without MTX, both great drug classes for RA
Equally so?
#ACR21 ABST0834 @RheumNow https://t.co/6wvzVrXTW6 https://t.co/fYEktJhZuV
David Liew drdavidliew ( View Tweet)