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#good news and bad news. Avacopan works v well for steroid sparing in #GPA. It’s an oral C5a receptor blocker - maintains more remission and less relapses and less total prednisone OP0180 @eular_org #EULAR2022 @RheumNow Bad news $$💰 will limit access.
Janet Pope Janetbirdope ( View Tweet)
#Bestinclass. #Giantcellarteritis GCA lots of novel ideas. V short prednisone- 2 months with #Tocilizumab. Not RCT. Looked safe & effective but too small to know if blindness etc are increased. Don’t suggest you try this at home...yet! @RheumNow @eular_org #EULAR2022 OP0185
Janet Pope Janetbirdope ( View Tweet)
#Bestinclass Recurrent #PMR RCT of #sarilumab v placebo. Nearly doubles sustained remission but maybe attenuating effect - flare difference over time? N=118. 🤷♀️ Dunno who I would use it in yet. LB0006 @RheumNow @eular_org #EULAR2022
Janet Pope Janetbirdope ( View Tweet)
Positive study NUT when to use the Rx? PMR RCTof 1 g #rituximab once. Over 1 yr with more steroid free remission - curves separate by 21 weeks (steroids off) POS0269 @RheumNow @eular_org #EULAR2023 when to use it-COVID risk, ?prefer IL6i
Janet Pope Janetbirdope ( View Tweet)
ARIAA: saw 18m results #EULAR2022
(alluded to at #ACR21)
High-risk ACPA+ clinically suspect arthralgias
Didn't progress to arthritis:
after 6m abatacept: 92% vs 65%
12m after abatacept stopped: 65% vs 43%
(tighter at points)
How to pick those that benefit?
POS0531 @RheumNow https://t.co/dkf1jU5gx7
David Liew drdavidliew ( View Tweet)
Sarilumab in pts with relapsing PMR - Phase 3 trial
Sarilumab +14 week steroid taper - higher sustained Remission than w/o sarilumab (28% vs 10%)
Less flare occurrences
Sarilumab noted to have higher incidences of neutropenia, arthralgia
@RheumNow #EULAR2022 ABST#LB0006 https://t.co/SeetkBsYI3
Robert B Chao, MD doctorRBC ( View Tweet)
PMR on the podium @profbdasgupta, with a positive phase 3!
Sarilumab in relapsing PMR (SAPHYR):
sari q2w+14w taper vs placebo+52w taper
underrecruited 118/280 (COVID) but still hit primary, almost all secondary
Better outcome + steroid-sparing: big
LB0006 #EULAR2022 @RheumNow https://t.co/nd3TSibYa0
David Liew drdavidliew ( View Tweet)
SAPHYR trial of sarilumab for relapsing PMR @profbdasgupta et al. Sarilumab+14 week steroids vs 52 week steroid monotherapy. Sustained remission 28.3% vs 10.3% P=0.0193. Flare after remission 16.7% vs 29.3% HR 0.56 (0.35–0.90) P=0.0158 @RheumNow #EULAR2022 https://t.co/oopWKjciWG https://t.co/xi4ELJiCXa
Links:
Richard Conway RichardPAConway ( View Tweet)
#LB0006 #EULAR2022 Therapy for relapsing polymyalgia rheumatica. 118/280 recruited re:COVID impact. Phase 3 RCT of Sarilumab+14Wk Steroid taper showed more pts had sustained remission at Wk52 vs PBO+52Wk Steroid Taper(28% vs 10%) even if CRP excluded. PRO improved too! @RheumNow https://t.co/P11iXIAfGn
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
ECLIPSE UK primary care dataset: 23 million pts @DrMaxYates1
1.
in >55yo, PMR prevalence 2.2%
(10,000 new dx/y)
2.
1/4 take PNL for >4y
(PMR = 18% of all pts on PNL)
3.
mean 3.5 comorbid dx (steroids worsen)
Now tell me we don't need better PMR therapies.
#EULAR2022 @RheumNow
David Liew drdavidliew ( View Tweet)
Sarilumab in PMR
SAPHYR Phase 3 RCT
Underpowered (<50% target recruitment)
-% remission sustained from wk12 to wk 52
28% vs 10% PBO
-Risk of flare reduced HR 0.56
-Improvement of several PROs
No new safety signal
LB0006 @RheumNow #EULAR2022 https://t.co/n7WdQxQaHo
Aurelie Najm AurelieRheumo ( View Tweet)
SAPHYR phase 3 RDBPCT study: #sarilumab vs PCB for relapsing #PMR on pred 7.5+ mg/d. Study met endpoints (whether of or not CRP was included). Time to first flare was longer w/SARI, less steroid use, and also better PROs. AE: #EULAR2022 LB0006 @rheumnow 1/2 https://t.co/lIspLKlveb
TheDaoIndex KDAO2011 ( View Tweet)
BRIDGE-PMR (rituximab in PMR) routine care extension to 52w
(in #PMRGCAJC one big qu asked was ?sustained benefit)
sustained benefit (RR 2.5 GC-free remission)
steroid-sparing (PNL 1.6g v 2.3g)
& ritux ?cheap enough now
but COVID calculus difficult
POS0269 #EULAR2022 @RheumNow https://t.co/Ln2ArclKO8 https://t.co/OtCwdjIPeL
David Liew drdavidliew ( View Tweet)
Therkildsen et al Ocular manifestations GCA in Denmark. Quite low proportion at 7%. Most occur around time diagnosis, with 1/3 pre-diagnosis. Aspirin not assoc reduced risk. @RheumNow #EULAR2022 POS0791 https://t.co/YgailfJ6fI
Richard Conway RichardPAConway ( View Tweet)
Cantoni et al. Maladaptive trained immunity in GCA. Aberrant activation of trained immunity programs in myelomonocytic cells leads to sustained and enhanced inflammatory activation and increased expression inflammatory cytokines (esp IL6) @RheumNow #EULAR2022 POS0492 https://t.co/A8t9gV1O3d
Richard Conway RichardPAConway ( View Tweet)
Palmowski et al. Glucocorticoids and bone density in GCA/PMR/other vasculitis from Rh-GIOP. Weird one, no increase in osteoporosis, no association with current or cumulative steroid dose and osteoporosis. Low BMI, vert #, PPIs were assoc osteoporosis. @RheumNow #EULAR2022 POS1139 https://t.co/n3d6YArXmU
Richard Conway RichardPAConway ( View Tweet)
De Miguel et al. Subclinical GCA in PMR shows different US pattern to classic GCA. Less cranial involvement and more isolated extra-cranial. About what you would have expected given clinical manifestations. @RheumNow #EULAR2022 POS0248 https://t.co/i9IZBdF1vQ
Richard Conway RichardPAConway ( View Tweet)
Joanna Robson @Robsonjo4 et al. Disease specific outcome measure for GCA (badly needed!) GCA-PROM. Demonstrated internal and external validity in measuring health related quality of life in GCA patients. @RheumNow #EULAR2022 POS0003 https://t.co/F8pLvlzqD1
Richard Conway RichardPAConway ( View Tweet)
Campaniello et al. Ultra-low dose RTX (500/1000mg once a year) vs low dose RTX (500/1000mg 6-monthly) for maintenance in AAV. Comparable relapse free survival 22.7% vs 21.2%, lower severe infection 10.5% vs 26.8% @RheumNow #EULAR2022 POS0837 https://t.co/uBgEmhLUzv
Richard Conway RichardPAConway ( View Tweet)
Dr Terrier @TerrierBen Mepolizumab gives clinical benefit in EGPA in terms of remission at week 36/48 and accrued remission. Benefit irrespective of presence of vasculitic features, ANCA status, clinical features, etc @RheumNow #EULAR2022 POS0836 https://t.co/GHwt1WNZEs
Richard Conway RichardPAConway ( View Tweet)
