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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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Don’t be ‘ticked’: TYK2 is not a JAK!
Recently the FDA approved deucravacitinib, a highly selective TYK2 inhibitor for psoriasis. Trials are positive in psoriatic arthritis and a phase II study in SLE. What about the effects? Presentations from the ACR22 meeting may provide answers.
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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)
Therapies for AS and nr-AxSpA are coming together. Both AS and nr-AxSpA present with similar burden of disease. TNFi, IL-17i and JAKi now approved for use in nr-AxSpA.
Jose U Scher, SpA Review @RheumNow #ACR22 https://t.co/vcHcd7OyAU
Dr. Antoni Chan synovialjoints ( View Tweet)
What do you do if a person with #rheumatoidarthritis was great on 1st JAKi. It was 1st line advanced Rx @RheumNow #ACR22
Janet Pope Janetbirdope ( View Tweet)
OPAL data is a gem! Large Australian data studying JAKi use in #rheumatoidarthritis N=5900 Switching JAKi~JAKi-common. As in TNFi 1st line Rx had longer retention & better efficacy than 2nd & subsequent. Median 1st advanced Rx - same in all JAKs 34 MOA @RheumNow #ACR22 abst0274 https://t.co/FQU4AKXwe9
Janet Pope Janetbirdope ( View Tweet)
Xeljanz in PsA (@pfizer funded) #ACR22 @RheumNow
⚠️safety data
-Pancytopenia
-Transaminitis
-Dyslipidemia
-Elevated CPK without #myositis
-Avoid in pregnancy and GI strictures
🤰Stop JAKi at least one month prior to conception🤰
Catherine Sims, MD DrCassySims ( View Tweet)
Xeljanz use in AS #ACR22 (@pfizer sponsored) @RheumNow
-Included patients with at least bilateral grade 2 SI or grade 3/4 unilateral SI
-5mg BID Xeljanz
-Significantly more patients had ASAS20/40 response, CRP reduction, & QOL, vs. placebo
-Onset of action noticed at 2 weeks https://t.co/DisKpgR0pt
Catherine Sims, MD DrCassySims ( View Tweet)
@MayoClinic data for bari in relapsing GCA caused waves at #ACR21
Spanish data looking at real-world practice: slightly longer, slower GCA, but equally encouraging outcomes
waiting for SELECT-GCA with interest! @EBRheum
ABST0464 #ACR22 @RheumNow https://t.co/pVRPXAohhc https://t.co/FgNNfPSWk3
David Liew drdavidliew ( View Tweet)
OPAL dataset 🇦🇺: 55000+ RA pts, 1/10 first line JAKi. Persistence > if 1st line,< x2 if 3rd line.
1/2 switch JAKi->TNFi
1/3 switch JAKi ->JAKi
Why high proportion of JAKi cycling, when AE reason for switch low?
https://t.co/APdWW7fzJE
Abst #0274 #ACR22 @Rheumnow @ClaireDeakin10 https://t.co/3xM3lQO1wI
Aurelie Najm AurelieRheumo ( View Tweet)
Very helpful slide on the different MOAs of JAK inhibitors (by Lui C et al.) shared by Dr. Langford
#ACR22 @RheumNow #RheumTwitter #yearinreview https://t.co/9VIOmzNoMq
sheila RHEUMarampa ( View Tweet)
