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ACR22: Polymyalgia Rheumatica in the Spotlight
One of the enduring legacies of ACR 2022 for me will be the emphasis on polymyalgia rheumatica (PMR). Despite being highly inflammatory and relatively common, a remarkable paucity of trials have been run in this space. Read on for a quick PMR-roundup from the meeting!
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Just so good to see PMR on the plenary stage at #ACR22, after #EULAR2022 too
SAPHYR study: sarilumab allows for
- a quicker steroid wean & less toxicity
- but also far more disease remission, quicker symptom resolution, better quality of life
Game-changing.
ABST1676 @RheumNow https://t.co/ZVqlMNoniu https://t.co/Fv3VRZrKGe
David Liew drdavidliew ( View Tweet)
Great moderating PMR talk w/@SattuiSEMD this AM; phenomenal slides @drceowen re:imaging in PMR
Big ?s:
-Who needs this? All/some/many
-Which modality? Nice summary slide
-How to treat "subclinical" GCA (risk of overtreatment imo)
Ideas for next year?
#ACR22 @rheumnow #ACRBest https://t.co/akvsud3YVO
Mike Putman EBRheum ( View Tweet)
Ab1676 #ACR22 SAPHYR: Sarilumab in Refractory PMR
52wk SAR 200 mg q2w + 14w taper GC v PBO+GC taper
Primary endpt: sustain response at 52w
Early term 2/2 COVID, 117 pt
SAR remission 28% vs PBO 10%, p=0.02
Data consistent when removes CRP data
PBO: more GCs 2/2 PMR flare
@Rheumnow https://t.co/kHq3juULX1
Eric Dein ericdeinmd ( View Tweet)
Sarilumab (IL-6R inhibitor) in phase 3 trial for relapsing PMR (SAPHYR trial).
Key inclusion: Disease flare while taking >7.5mg prednisolone
Sustained remission: resolution of symptoms, normalisation of CRP, adherence to prednisolone taper
@RheumNow #ACR22 #Plenary
Julian Segan JulianSegan ( View Tweet)
Spiera et al. Sarilumab in refractory PMR (SAPHYR) - Phase 3 RCT. Significant effect of IL-6i. @RheumNow #ACR22 Abstr#1676 https://t.co/2MS441B8gU https://t.co/jBd7YJKrTs
Richard Conway RichardPAConway ( View Tweet)
SAPHYR results: SAR + 14 wk GC taper showed efficacy vs comparator arm in steroid refractory PMR, including clinically meaningful improvement in QoL. No new safety signals. Plenary Abs 1676 #ACR22 @RheumNow https://t.co/mHu3e9JbCp https://t.co/93kbczSTfS
Dr. Rachel Tate uptoTate ( View Tweet)
This slide reminds me of a recent case I encountered 🧐
How can we differentiate #vasculitis vs. atherosclerosis? 👇
TAK - stenosis occurs in proximal arteries, thoracic aneurysms, US: conc, smooth thickg w/ long segment stenosis
#ACR22 @Rheumnow #RheumTwitter @rheumarhyme https://t.co/So4VKsfBm4
sheila RHEUMarampa ( View Tweet)
Sarilumab (SAR) + 14 wk GC taper demonstrated significant efficacy vs the comparator arm in steroid refractory PMR patients and improvement in quality of life. Sustained remission was 28.3% SAR vs 10.3% comparator arm. Spiera R Abs#1676 https://t.co/gXGJzbYLHK #ACR22 @RheumNow https://t.co/oZBsRtxMUw
Dr. Antoni Chan synovialjoints ( View Tweet)
Interesting study (MAGICA) of withdrawing TCZ in GCA after 1 year of therapy
Comparing abrupt vs gradual discontinuation
Very important clinical quesiton; kudos to FVSG for making this happen!
#ACR22 #Vasculitis22 @RheumNow https://t.co/912GCFik6L
Mike Putman EBRheum ( View Tweet)
PMR is no a disease of vague shoulder and hip pain.
It's something much more specific:
a chronic inflammatory disease of musculotendinous structures.
We're starting to understand the real story.
@drceowen lays it out for #ACR22 this morning
@EBRheum @SattuiSEMD @RheumNow https://t.co/thqtCwSULM
David Liew drdavidliew ( View Tweet)
How do we know what PMR is all about?
Imaging has helped enormously, and every step of the way, imaging has got better and better. Specific findings which reveal the culpable pathology.
@drceowen #ACR22 @RheumNow https://t.co/4OOOk0F3jW
David Liew drdavidliew ( View Tweet)
Terrier @TerrierBen et al. PNEUMOVAS -pneumococcal vaccination in AAV treated with RTX Double dose of PCV13 at day 0 and day 7 followed by single dose of PPV23 at month 5 significantly improves antibody responses (2 in figure) @RheumNow #ACR22 Abstr#L016 https://t.co/qKqgvv7ZwI https://t.co/UHCuZNSF54
Richard Conway RichardPAConway ( View Tweet)
Promises to be a fantastic session!
🌟Delighted PMR is getting the attention it deserves 🌟
2pm GMT/ 9am EST
#ACR22 @RheumNow
@SattuiSEMD @EBRheum @drceowen https://t.co/ShRTS1DLXO
Patricia Harkins DrTrishHarkins ( View Tweet)
van Nieuwland et al. Comparison US/PET/MRI in GCA. Good specificity but relatively low sensitivity for all. PET best for extra-cranial. MRI/US best for isolated cranial. @RheumNow #ACR22 Abstr#1617 https://t.co/CI3TtxOQJL https://t.co/3pJeGo49Gj
Richard Conway RichardPAConway ( View Tweet)
Stamatis et al. MI in systemic vasculitis vs controls. Only difference - less likely to have pre-existing CVD. No significant difference in outcomes - but this may be due to underpowered - see Figures. @RheumNow #ACR22 Abstr#1615 https://t.co/bYtMr1jGXN https://t.co/QABW2GiVFl
Richard Conway RichardPAConway ( View Tweet)
Is #Tofacitinib an option in #PMR poly myalgia rheumatica? RCT of Tofa 5 mg bid vs prednisone 15 mg/d and tapering. Equal results. Needs a phase 3 trial but could be an option if needing to avoid prednisone ex osteoporosis, DM, etc. abst#1107 #ACR22 @RheumNow https://t.co/OgcgslwaB5
Janet Pope Janetbirdope ( View Tweet)
Rhee @RennieRhee et al. Combined cranial vessel wall and orbital MRI for GCA. Improves sensitivity 77% vs 69% with loss of specificity 91% vs 95%. Identifies abnormalities in some without visual symptoms - at risk of vision loss @RheumNow #ACR22 Abstr#1618 https://t.co/OtGm7sEWtU https://t.co/YM4WLahubH
Richard Conway RichardPAConway ( View Tweet)
Sarilumab demonstrated efficacy in difficult to treat GC resistant PMR patients. Abs 1543 #ACR22 @RheumNow https://t.co/TCo5g5i1qh https://t.co/tZOhvvuhpY
Dr. Rachel Tate uptoTate ( View Tweet)
Refractory cystoid macular edema assoc'd w/ Bechet's uveitis can be effectively treated either with ADA, IFX or TCZ. Abs 1564 #ACR22 @RheumNow https://t.co/WcEI4d0Cl5 https://t.co/Tk0T41coog
Dr. Rachel Tate uptoTate ( View Tweet)
