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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
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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)
#1156
@DidemSayginMD et al finds that ~1/3 patients with myositis have comorbid fibromyalgia
➡️Presence of fibromyalgia significantly impacted patient global disease activity
#acr24 @RheumNow https://t.co/u1XfqrQU1H
Caoilfhionn Connolly CaoilfhionnMD ( View Tweet)
Petri recommends IM triamcinolone as safer than prednisone dosing per FLOAT trial, decreased risk of fx
@RheumNow #ACR24
@jhrheumatology https://t.co/vhMRdSkBAA https://t.co/novlGcss6x
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Eric Dein ericdeinmd ( View Tweet)
Positive impacts of registry participation across outcomes.
#ACRBest #ACR24 @RheumNow https://t.co/BgaNLfHaF1
Mrinalini Dey DrMiniDey ( View Tweet)
Late-onset asthma but earlier EGPA diagnosis?
Abstract 1604 used IQVIA data to develop a machine learning model for better EGPA dx. Key predictors included eosinophilia, asthma, chronic sinusitis, multiple CXRs, skin biopsies, and GC prescriptions. @RheumNow #ACR24
Akhil Sood MD AkhilSoodMD ( View Tweet)
Sukumaran et al. Does does of IA steroid matter in knee injection? RCT 30 patients. Triamcinolone. 6-week WOMAC decrease 6% in 10mg, 10% in 20mg , 29% in 40mg @RheumNow #ACR24 Abstr#1186 https://t.co/WUYiEP5dSo
Richard Conway RichardPAConway ( View Tweet)
#1477 🔬Zasocitinib (TYK-2i) shows promise in phase IIb RCT
➡️n=290, randomised to PBO, 5/15/30mg gps
💥30mg group
📉 Rapid skin improvement @ Wk 2
➡️Wk 12 PASI:~2X placebo (-2.5;p=0.004)
🛟Well tolerated
⬆️MDA (28 v. 12.5% p<0.05) promise for other PsA domains
#ACR @RheumNow https://t.co/5GusMlVkQ4
Caoilfhionn Connolly CaoilfhionnMD ( View Tweet)
Exciting early data for new highly selective TYK2i zasocitinib
Improved PASI skin scores (though not as much as IL23i...)
Funky skin-related adverse events at higher doses, not sure what to make of that?
#ACR24 @rheumnow Abstr#1477 https://t.co/CtOFsoHdBh
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Mike Putman EBRheum ( View Tweet)
T2T approaches in early PsA:
-STAMP trial (open label, multicenter RCT) eval early SEC (300mg+ MTX15+ 80mg steroid injection) vs SoC (MTX25+80mg steroid injection)
-At week 12, 38% pts on SEC vs
17% on SoC achieved ACR50. Also did better on MDA & PASI.
-No significant… https://t.co/MflI3d0FqV https://t.co/RjnzeaTyQK
Links:
Adela Castro AdelaCastro222 ( View Tweet)
How do you treat a flare of SLE with steroids?
@RheumNow #ACR24
Eric Dein ericdeinmd ( View Tweet)
Petri: 5 mg prednisone or less is our standard for lupus control
EULAR 23 recs - early addition of immunosuppressant and/or biologics instead to prevent steroids
@RheumNow
#ACR24 @jhrheumatology https://t.co/jhxEeboPu5
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Eric Dein ericdeinmd ( View Tweet)
RheumNow’s expanded coverage of the #ACR24 meeting is sponsored in part by Bristol Myers Squibb and UCB. All content is chosen by RheumNow & its faculty
Dr. John Cush RheumNow ( View Tweet)
New agent on the block: Bimekizumab IL-17A/F inhibitor
Promising clinical data in SpA - what about imaging findings?
Dramatic reductions in MRI activity at SI joints seen in BKZ pt, esp when compared to trajectory of PBO pt before cross-over
@RheumNow #ACR24 Abst #1757 https://t.co/ACLJx5XkyN
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
At "Envisioning a Steroid Free Future" talk
Angelo Gaffo at the mic: "Are there any situations you would do induction therapy for AAV without steroid?"
John Stone: [pause] "No." 😄
#ACR24 @RheumNow
Mike Putman EBRheum ( View Tweet)
#1462 🔬Rx persistence in PsA; Guselkumab (GUS) v. IL17Ai
💡 GUS (n=910) persistence @ 12 months (67%) almost 2X IL-17Ai (n=2743) (50%)
⏳ Median time to discontinuation: GUS not reached v 12.3 months for IL-17Ai.
🔴Durable therapy ❓better outcomes
#ACR @RheumNow https://t.co/LfA3WygNVq
Caoilfhionn Connolly CaoilfhionnMD ( View Tweet)
Reset the bar for remission (off steroids)!! Session #17S19
3% higher risk of organ damage for each 1mg of pred
Remission possible in rheum with lower dose GC regimen and faster taper #GCStewardship
#ACR24 @RheumNow @BethIWallace
Jiha Lee JihaRheum ( View Tweet)