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ACR Best Abstracts - Day 1
The RheumNow faculty reporters have been scouring the meeting and online presentations to find the best abstracts from ACR22. Here are some of their choice abstracts reported today on day 1 of ACR 2022 (#ACRbest).
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Pike et al. Deucravactinib (TYK2i) in SLE. + on SRI(4) week 32. + SRI(4),BICLA, LLDAS, CLASI-50, swollen and tender joint counts week 48. Strange, the lowest dose (3mg bd) seems best. @RheumNow #ACR22 Abstr#1117 #ACRbest https://t.co/o4902tvZs8 https://t.co/t8oeMRGUS7
Richard Conway RichardPAConway ( View Tweet)
TOFA and MTX: which one to withdraw first?
RCT in 100+ RA pts in remission after 1 yr, 1 yr follow-up
Withdraw MTX grp: Remission 30% LDA 40%
Withdraw TOFA grp: Remission 50% LDA 65%
diff NS small sample
8 SAEs, 72% recovery
https://t.co/tMnet32TWF
Abs#1586 #ACR22 @Rheumnow https://t.co/PWnkWYdlGk
Aurelie Najm AurelieRheumo ( View Tweet)
#abst2132 #acr22 @rheumnow safety of Deucravacitinib Ph2PsA&ph3PSO trial: no Δ from BL in hematology, chemistry, or lipid labs. JAK 1/2/3 Effects on hem, hepatic, CPK, and cholesterol lab parameters not observed over 16 wks of DEUC at doses up to 12 mg QD & in combo w/csDMARDs. https://t.co/bjGEYp4GcJ
Olga Petryna DrPetryna ( View Tweet)
Plenary:
Tyrosine kinase 2 (TYK2)
◦ Mediates signaling of Type I IFNs, IL-23, and IL-12
◦ Key cytokines involved in lupus pathogenesis
◦ Deucravacitinib oral TYK2 inhibitor
◦ Phase 2 RCT in SLE showed efficacy
Pike M Abs1117 https://t.co/eJhNsM02Vl #ACR22 @RheumNow https://t.co/C6JQqR1DLj
Dr. Antoni Chan synovialjoints ( View Tweet)
Phase 2 efficacy and safety of deucravaticinib (TYK2i) in mod-severe SLE. Met primary endpoint (SRI4) for 3mg and 6mg doses (but not 12mg). No signal for HZ but increased oral herpes. Bigger numbers will be helpful.
@RheumNow #ACR22 #plenary #ACRBest https://t.co/SjW1OSQzdM
Julian Segan JulianSegan ( View Tweet)
Fascinating Abs 0653 #ACR22 In vitro models show JAKis counteract celluar cytotoxicity of HCQ in a human retinal pigment epithelial cell line and podocytes. Possible new way to dec. retinopathy/nephropathy? @RheumNow
https://t.co/5NtLoDzjKG https://t.co/GG2R03xAes
Dr. Rachel Tate uptoTate ( View Tweet)
Ab1117 #ACR22 Deucravacitinib: TYK2 inhibitor in active SLE?
363 pt P2, double-blind PBO-controlled 48 wk study
DEUC 3 mg BID, 6 BID, 12 QB vs PBO:
At 32wk: DEUC 3BID & 6BID > PBO, sustained across all groups at 48wk.
AEs: similar bw PBO and DEUC. No VTE
@RheumNow #ACRBest https://t.co/uamJe05odq
Eric Dein ericdeinmd ( View Tweet)
Tofa 5 mg BID successful in treating refractory uveitis in reducing inflammation and reducing steroid dosage. Abs 1041 #ACR22 @RheumNow https://t.co/dtAEhW7dEG https://t.co/Xbw2iEsYHh
Dr. Rachel Tate uptoTate ( View Tweet)
Kahlenberg @Kahlenberglab et al. TYK2i deucravacitinib in SLE. Clinical efficacy (figure). Deucravacitinib suppressed IFN production, IFN-responsive gene expression, IFN-inducible proteins, B cell markers,serological biomarkers. @RheumNow #ACR22 Abstr#1000 https://t.co/zzkoPLOlSR https://t.co/znyG8N5pJ2
Richard Conway RichardPAConway ( View Tweet)
Johnson et al TYK2i deucravacitinib does not inhibit haematologic pathways, Treg function, or IL-15 dependent NK cell function, that JAKi do. @rheumnow #ACR22 Abstr#0584 https://t.co/UTHzUjGmJN https://t.co/NUKKAv3tAr
Richard Conway RichardPAConway ( View Tweet)
Trend of reduced opioid use when initiating biologics and JAKi in RA though effect size small and very high baseline use (>50%) in this insurance claims database.
Residual pain and harm minimisation still areas of need.
@RheumNow #ACR22 ABST0925
https://t.co/XGHu0fIMF0 https://t.co/PutNNQiKnY
Julian Segan JulianSegan ( View Tweet)
JAK and TYK-2 inhibitors and indications in SpA:
● Tofacitinib ➣ Pan JAKi (AS, PsA)
● Baricitinib ➣ JAK1,2
● Upadacitinib ➣ JAK1 (AxSpA, PsA)
● Deucravacitinib ➣ TYK2 (PsA)
Carol Langford, Year in Review #ACR22 @RheumNow https://t.co/EMLEvptySS
Dr. Antoni Chan synovialjoints ( View Tweet)
Across 9 trials of Upadacitinib in RA, PsA and AS, 40%–50% of patients had ≥ 2 CV risk factors, ≥ 65 years 6%–23%. Rates of adjudicated MACE and VTE with UPA were infrequent, consistent with background rates in RA, PsA, and AS Abst 0510 https://t.co/HDkQ6ELnAy #ACR22 @RheumNow https://t.co/SRJYdFFNIQ
Dr. Antoni Chan synovialjoints ( View Tweet)
Post hoc analysis from the SELECT-PsA 1 trial by Dr. @DrLauraCoates and team:
💊Pts on UPA showed greater improvement from BL in RAPID3 vs. ADA in all visits
💊Pts on UPA had better responses in all assessments vs. PBO
Reassuring data. #ACR22 @RheumNow ABST0192 https://t.co/NgeUU5bPPf
sheila RHEUMarampa ( View Tweet)
SELECT-AXIS 2 subgroup analysis. UPA demonstrated improved efficacy vs PBO at Wk 14 across all evaluated subgroups of pts with bDMARD-IR AS. No new safety signals. @XBaraliakos et al, Abs 0414 #ACR22 https://t.co/lTfm68XlEY https://t.co/PaWdrOljMO
Dr. Rachel Tate uptoTate ( View Tweet)
Abs 0419 SELECT-AXIS 2, UPA improved outcomes vs PBO in nr-axSpA pts across all BL inflammation subgroups; greatest benefit obs in pts with both elevated CRP and inflammation on baseline MRI. #ACR22 @RheumNow https://t.co/opaFwXgcvU https://t.co/o27ULcL8Ip
Dr. Rachel Tate uptoTate ( View Tweet)
2022 ASAS-EULAR Recommendations of AxSpA management
1) NSAIDs still first line
2) Analgesics/opioids contraindicated
3) TNFi, IL-17i first line bDMARDs, followed by JAKinibs
4) Tapering but not discontinuation of bDMARDs in sustained remission
Abs#0542 @RheumNow #ACR22 https://t.co/ffaN2fMc3v
Robert B Chao, MD doctorRBC ( View Tweet)
Rates of MACE and VTE with upadacitinib were infrequent and consistent with background rates in RA, PsA and AS patients. Factors associated with MACE/VTE: age>65, HTN, DM, smoking, history CV event/VTE
Abs#0510 @RheumNow #ACR22 https://t.co/AjtJF0p3QK
Robert B Chao, MD doctorRBC ( View Tweet)
Key points in managing MDA5+ DM
1. Consider Tofacitinib 5-10mg bd
2. Low to mid dose Prednisolone 20-30mg tapering
3. Other Rx: Tacrolimus, IVIG
4. Poor prognostic factors: lymphopenia, raised ferritin, old age, rapid ILD progression
Wang GC, IIM session @RheumNow #ACR22 https://t.co/UF2PjAg0Mw
Dr. Antoni Chan synovialjoints ( View Tweet)
