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Spicy network SRMA, 123pts w/JAK-TNF-PLBO
TNF >> JAK w/respect to malignancy (expected) & better than PLBO (spicy!)
JAK > PLBO for heme cancers (makes sense); no significant (but slight trend) toward PLBO > JAK for all cancer
The debate continues
#ACR24 @RheumNow Abstr#0989 https://t.co/tBnb02gyzF
Mike Putman EBRheum ( View Tweet)
Brenac et al. Orbital MRI to distinguish GCA AOIN/CRO from non-arteritic. @RheumNow #ACR24 Abstr#1641 https://t.co/qIwaX3qp02 https://t.co/5CIZ0aV98Z
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Richard Conway RichardPAConway ( View Tweet)
Which RA patients are at increased risk of JAKi adverse events? Does disease activity matter?
in the upadacitinib ph3 trials, high disease activity pts had more:
serious infections
HZ
MACE
VTE
Active RA is a massive contributor to many AEs in JAKi pts
#ACR24 ABST1393 @RheumNow https://t.co/DlFf9Sfbja
David Liew drdavidliew ( View Tweet)
Koc et al. STAMP trial in PsA. Secukinumab+MTX+GC vs MTX+GC(+SSZ if needed). Both could go to TNF if needed. Secukinumab significantly better at week 12 but no longer at week 24. @RheumNow #ACR24 Abstr#1457 https://t.co/4TGSiUPebV https://t.co/eAANkYIpzy
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Richard Conway RichardPAConway ( View Tweet)
Harkins @DrTrishHarkins et al. PROs predict relapse in PMR. pVAS, HAQ health status, FACIT-F all positive predictors. Interestingly PHQ-9 negative predictor. @RheumNow #ACR24 Abstr#1238 https://t.co/kj4WgmI0oq https://t.co/xLDzRZvxoA
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Richard Conway RichardPAConway ( View Tweet)
Gottlieb et al. TYK2i Zasocitinib in PsA. 12 week phase 2 RCT. Skin responses and MDA all favour zasocitinib but maybe not fantastic? PASI75 46%, PASI90 37%, PASI100 26%. MDA in photo. @RheumNow #ACR24 Abstr#1477 https://t.co/iX5iriESV2 https://t.co/RkEmcAZ80x
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Richard Conway RichardPAConway ( View Tweet)
Zhang @jeffsparks et al. Even more evidence that MTX does not cause ILD, and in fact prevents ILD, in RA, OR 0.48 in meta-analysis. @RheumNow #ACR24 Abstr#1384 https://t.co/YvQnmmvNjF https://t.co/crYUwHahDb
Links:
Richard Conway RichardPAConway ( View Tweet)
The idea of patient-initiated follow-up for RA is enticing:
patient & physician time is already stretched
minimize unnecessary visits/improve access
but what actually needs to go into the design, to make it safe/workable?
A: plenty.
🇨🇦 pilot underway
#ACR24 ABST1041 @RheumNow https://t.co/03u4bhnQ0v
David Liew drdavidliew ( View Tweet)
STAR trial of GC w/d in RA LDA
SEMIRA of GC w/d controlled RA on Toci
Very slight disease activity increase, but higher flares
No symptomatic adrenal insufficiency, but data of abnormal ACTH stim
No good evidence of steroid w/d symptoms
Beth Wallace
@RheumNow #ACR24 https://t.co/j6UPWlVNIu
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Eric Dein ericdeinmd ( View Tweet)
Slick poster, but must be careful w/real world data. Big risk of confounding/channeling bias
Pts with MACE risk (not always well-characterized by ICD codes) also less likely to receive JAK & therefore less liekly to have subsequent MACE
#ACR24 @RheumNow Abstr#1394 https://t.co/lilU0byJ1s
Mike Putman EBRheum ( View Tweet)
Zhou et al. Phase 2 RCT of XKH004, IL17A/Fi in AxSpA. ASAS40 50.4% vs 25%. Slightly odd dose response variation, but maybe just noise. @RheumNow #ACR24 Abstr#1453 https://t.co/SsTSThFzro https://t.co/C9yK2G4tqB
Links:
Richard Conway RichardPAConway ( View Tweet)
Getting more data on using deucravacitinib for PsO/PsA manifestations
Impressive effect on scalp psoriasis (which often means a lot to patients)
Given how safe it is, it's increasingly tempting to use more of it in mild-mod PsA
#ACR24 PSORIATYK SCALP trial ABST1137 @RheumNow https://t.co/vxS3RSlIN0
David Liew drdavidliew ( View Tweet)
Cowley et al. US pattern in Subclinical GCA in PMR vs GCA. Subclinical GCA has more isolated axillary artery involvement. Severity of US inflammation significantly higher in GCA than subclincal GCA @RheumNow #ACR24 Abstr#1629 https://t.co/6Iyx76YgkS https://t.co/DxzTEwE5J5
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Richard Conway RichardPAConway ( View Tweet)
Abst #1473 evaluated association of SJC in PROs from 2 Bimekizumab trials (bDMARD naïve vs TNFi-IR)
-bDMARD naïve had less SJC at baseline
-In both groups, pts w lower SJC had sustained improvement in pain and fatigue over time.
#ACR24 @RheumNow https://t.co/zwxsSbga7c
Adela Castro AdelaCastro222 ( View Tweet)
Findings from Abstr#1436 reveal that cigarette smoking is not positively associated with radiographic progression in psoriatic arthritis (PsA). Current and past smokers showed a longer time to joint damage progression. This suggests a complex relationship that warrants further… https://t.co/ERsAKoivA4
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
What do current national/international rheumatology association guidelines say about perioperative discontinuation of biologics?
it's highly, highly variable
no wonder people get confused!
#ACR24 ABST1037 @CatherineL_Hill @RheumNow https://t.co/cmJ3qKU1QT
David Liew drdavidliew ( View Tweet)
Serrano-Combarro et al. Case series of upadacitinib in RA-ILD. 18 patients. Report stable/improved dyspnoea and HRCT over 12 months. PFTs shown, relatively stable @RheumNow #ACR24 Abstr#1372 https://t.co/yncy0lPq60 https://t.co/mrDMtEDwUt
Links:
Richard Conway RichardPAConway ( View Tweet)
Great table re:side effects of even low dose steroids in RA
Likely generalizes to other diseases ie PMR, SLE
P in prednisone stands for poison!
#ACR24 @RheumNow https://t.co/0opDEtzm9E
Mike Putman EBRheum ( View Tweet)
How do we prevent SLE flares requiring steroids?
Petri:
Background medication!
HCQ adherence is key
-check WB levels to measure
EULAR recs early addition of immunosuppress/biols
“Taper quickly, withdraw slowly”
Come down quick, then slowly off
@RheumNow #ACR24 @jhrheumatology
Eric Dein ericdeinmd ( View Tweet)
Are biosimilar multi-switches an issue?
real world data: DANBIO 🇩🇰
biosimilar to biosimilar switch
having already had a switch prior ('previous ADAo') did not increase cessation
The risk of biosimilar switching on immunogenicity is greatly overstated
#ACR24 ABST1000 @RheumNow https://t.co/1yAfZrrNd0
David Liew drdavidliew ( View Tweet)