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Stopping therapy in GCA

David Liew, FRACP Oct 29, 2025

They say the easiest bit about GCA, like PMR, is the first week after you start steroids. Those fond memories belie the challenge of ongoing treatment in GCA. In a steroid-only world, there is only misery. Steroid-sparing therapies have changed this completely.

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ACR 2025 - Day 3 Report

Jack Cush, MD Oct 28, 2025

Day 3 in Chicago is hump day, the last big full day of presentations and posters. The day began with an 8AM plenary session, which brings me to the first of my three notables from today:

When should you order a renal bx in suspected #LN? Active urinary sediment Used to be #UPCR 500g/g or more Abst#772 looked at UPCR 250g/g to 499 71% + LN and half needed Rx esp if Low C3,C4 Black race Petri, Baltimore #lupus #cohort #ACR25 @ACRheum @RheumNow

#Ianalumab decreases disease activity in active #Sjögren's #disease 2 phase3 DB #RCT added to #SoC in primary #SjD >90% #Ro+ +#ESSDAI in monthly sc dosing vs placebo, Many 2ndary outcomes improved, safe LB#24 #ACR25 @ACRheum @RheumNow #ACRBest https://t.co/Z4ooUg7Nos

TAC+MMF + GC vs TAC +GC in lupus nephritis (target trial emulation): 🔹Higher total renal response w/ TAC + MMF + GC at 12 mo (59.7% vs 33.3%) consistent in ITT & per-protocol 🔹similar adverse events reported (14.6% vs 16.4%) @RheumNow #ACR25 https://t.co/Yuql3O9C8X

https://x.com/AkhilSoodMD/status/1983590907095011839/photo/1

#ACR25 Abstr#2695 Inguinal lymph node biopsies pre- and post-OBI, RTX, BLIN & CD19 CAR-T showed complete tissue depletion with CAR-T. B-cells reduced but often incomplete with protein-based depleters; OBI being the best. Still don’t agree with “immune reset” @RheumNow #ACRBest https://t.co/Sq7m9sXlLP

#2682 In a randomised trial of 320 RA patients, the recombinant zoster vaccine (RZV) was safe and did not trigger disease flares. But methotrexate use and older age significantly blunted antibody responses ➡️key factors to consider for vaccine strategies in RA. @RheumNow #ACR25

kids w 👇 Undifferentiated #systemic #autoinflammatory #disease Rx #IL1i N=33 =boys &girls 3.5 yrs Sx Abst#2151 #ACR25 @ACRheum @RheumNow There are many periodic fever syndromes 🤔some mutations are not yet discovered Access to &use of Anakinra canukinumab Rilonacept https://t.co/IyTx0nFxKC

https://x.com/Janetbirdope/status/1983584894690189449/photo/1

#2659 In a large real-world target trial (>1.3M with T2D), SGLT2 inhibitors, esp dapagliflozin & empagliflozin, were assoc with lower risks of RA, lupus, vasculitis & other autoimmune rheumatic diseases vs DPP-4 inhibitors. Possible immune benefits of SGLT2i? @RheumNow #ACR25

Abstract 2697: Compared to MMF, tacrolimus showed - similar SRR by week 96 (58.5% vs. 69.2%, OR 0.62; 95% CI 0.29-1.29) - similar time to renal AE/deaths (HR 0.70; 95% CI 0.37-1.35) - serious AEs less frequent (12.3% vs. 30.8%) @RheumNow #ACR25 https://t.co/o3LtgOp7St

https://x.com/AkhilSoodMD/status/1983581595979117052/photo/1

#ACR25 Abstr#2697 H2H RCT of Tacrolimus + GC vs MMF + GC in #lupus Nephritis in Asia for Induction-Maintenance showed similar efficacy. Different side effects: AKI more in TAC, low WCC & infections in MMF. Informative for services with no access to biologics/Voclosporin @RheumNow https://t.co/V4uWhuqjjW

https://x.com/Yuz6Yusof/status/1983578834315157825/photo/1

#2658 In >870k adults with T2DM or obesity, GLP-1 receptor agonists showed no increase in autoimmune or inflammatory disease risk, and were instead linked to lower mortality, heart failure, stroke and dementia. Excellent real-world safety signals. @RheumNow #ACR25

Abstract 2695: Deep dive into B-cell depletion (BCD) Lymph node biopsy pre/post tx: 🔹 CAR T: complete BCD + disrupted follicular architecture 🔹 RTX, OBI, BLIN: reduced BCD + preserved follicular architecture ✅ Complete LN depletion → drug-free remission @RheumNow #ACR25

Year in Preview SLE: 52% subtherapeutic on weight based HCQ dosing Precision prescribing needed, more so for CKD @RheumNow #ACR25 Abstract 1722 https://t.co/8WqorQ1xJx

https://x.com/JihaRheum/status/1983555467344310342/photo/1

Hydroxychloroquine in SLE is all about the sweet spot. Not too hot with retinopathy, not too cold with flares, just right by the levels. Yet drug concentrations and TDM are not commonplace in many places - time for change Laura Coates in the #ACR25 meeting review @RheumNow https://t.co/oB3ecfSQQc

https://x.com/drdavidliew/status/1983555247269404896/photo/1

Year in Preview GCA: GC over-prescribed, bDMARDs more effective than MTX, and more options available (TOC, JAKi) @RheumNow #ACR25 https://t.co/L9fx1LCCnw

“We’ve got to do better for our patients with GCA” - Laura Coates, doing the #ACR25 meeting review She told us she is speaking about diseases outside her comfort zone but she is bang on. As she said: not good enough real world all the people not on steroid-sparing Rx @RheumNow https://t.co/4WiEORwPgI

https://x.com/drdavidliew/status/1983554079453483409/photo/1

Sjogren’s disease: is it maybe true you need to still have some salivary function left to get benefit from therapy? Ianalumab (BAFF inh) ph3 NEPTUNUS-1/2 Very decent on primary (ESSDAI) & we will see this Salivary flow only improved when some at baseline #ACR25 LB24 @RheumNow https://t.co/uGwKdN3Dsh

Effectiveness of b/tsDMARDs RA pts kidney dysfunction CorEvitas RA registry 9,569 pts Pts low eGFR = older more comorbidities less NSAIDs Reduced eGFR = 30% less likely to achieve remission Persists indeed of GC intake Is it a PK/PD related issue or somehow the reflection of https://t.co/KZuvPVa6eg

https://x.com/AurelieRheumo/status/1983535872038363477/photo/1

b/tsDMARD in RA + CKD (eGFR <60) From >12K pts in CorEvitas: - overall effective but 30% ↓ CDAI-emission (HR 0.71) - Findings consistent across TNFi, IL-6i, ABA BCDT, JAKi @RheumNow #ACR25 A#2640 https://t.co/UOP9ejZKoA

https://x.com/JihaRheum/status/1983519940041707709/photo/1

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Stopping therapy in GCA

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