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Update on Axial SpA at EULAR 2022
This year at EULAR 2022, there were important and interesting topics in Axial Spondyloarthritis (AxSpA). These are my picks of abstracts from the conference.
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Malignancy risk on b/tsDMARDs in patients with prior malignancy history
For autoimmune patients with a history of malignancy, the initiation of biologic or targeted synthetic disease modifying agents (bDMARD/tsDMARDs) may provoke concern.
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#ClinicalPearl Oral Surveillance chance of having a MACE was highest....you guessed it, in those with past MACE events. Some CV risks have different risks ex HTN May have less risk vs high cholesterol @RheumNow @eular_org #EULAR2022 POS0237 https://t.co/kTn4rxMlej
Janet Pope Janetbirdope ( View Tweet)
We’re in the #EULAR2022 highlights: basic/translational first. Wait, don’t go…
because Temra cells are cool. Up in RA pts who are TNFi-IR, & may actually be more than a bystander.
Understanding TNFi resistance is path to:
predicting it
knowing best what to do with it
@RheumNow https://t.co/22Y6iinSbH
David Liew drdavidliew ( View Tweet)
McInnes @IainBMcInnes1 et al. Bimekizumab (IL17A/Fi) in PsA. BE OPTIMAL 852 patient RCT vs PBO vs ADA. Looks same for joints, better for skin than ADA (not stat sig) @RheumNow #EULAR2022 LB0001 https://t.co/oKEHJE3tGn https://t.co/H7nPnbEWUB
Links:
Richard Conway RichardPAConway ( View Tweet)
What drives residual pain improvement in #JAKi treated pts? Dunno but #Baricitinib and #Sarilimab showed better pain decrease vs placebo and #Adalimumab. #OP0052 showed both #Tofacitinib & Adalimumab reduced pain more than placebo in PsA & RA if in remission @RheumNow @eular_org
Janet Pope Janetbirdope ( View Tweet)
Michielsens et al T2T tapering of TNFi in AxSpA and PsA. 72% tapered, 28% discontinued TNFi. Month 12 LDA 69% vs 73%.Month 12 dose 53% vs 91%. Flares 85% vs 78%. Needed more NSAID 54% vs 24% and steroid 30% vs 17%. @RheumNow #EULAR2022 OP0261 https://t.co/EDBPOgg4sX https://t.co/ckPqaTdm4B
Links:
Richard Conway RichardPAConway ( View Tweet)
VIGIBASE registry RA
39000+ pts JAKi and 231000+ pts TNFi
*No increase in MACEs with JAKi 1.4% vs. 0.9%
*JAKi Increase in DVT RR 3.99
and PE RR 3.5
adjusted on age and sex
@RheumNow #OP0268 #EULAR2022 #Lupus https://t.co/hiAvKctgky
Aurelie Najm AurelieRheumo ( View Tweet)
Female PsA patients on TNFi have reduced treatment effectiveness, LDA (vs males). #EULAR2022 POS0077 @RheumNow https://t.co/EwDwxUarNb https://t.co/W5xgQlrnlF
Dr. Rachel Tate uptoTate ( View Tweet)
Ok to taper?
In PsA and AxSpA pts on TNFi, a T2T w/ tapering strategy was non-inferior to a T2T w/o tapering.
69% of tapered group remained in LDA, 73% no-taper group in LDA after 12 months.
Taper group did use more NSAIDs, cDMARDs, steroids
@RheumNow #EULAR2022 ABST#OP0261
Robert B Chao, MD doctorRBC ( View Tweet)
Nyam et al. JAK-pot study. >90000 treatment courses. No difference in aHR for treatment stop due to adverse events in JAKi vs TNFi or non-TNF bDMARD. @RheumNow #EULAR2022 OP0266 https://t.co/3tgADvH1Bq https://t.co/2qLRzfMB9c
Links:
Richard Conway RichardPAConway ( View Tweet)
#EULAR2022 POS0213
Beware of paradoxical low lipids in RA!
⭐️ETN+MTX vs MTX T2T:
Early ETN: increased in HLD, lesser LDL, differs from MTX. Correlates with clinical disease activity
@RheumNow https://t.co/c6GXadVwYN
Eric Dein ericdeinmd ( View Tweet)
Szekanecz et al. ORAL Surveillance. Geographic differences in MACE largely driven by history CVD and high baseline risk in North America and ROW. @RheumNow #EULAR2022 POS0110 https://t.co/cR6a7N2KP5
Richard Conway RichardPAConway ( View Tweet)
TNFi were going to unleash a TB wave
What has the biologic era really done for TB & opportunistic infx?
Hospitalised data from Western Australia post-2003:
TB actually not up (screening)
myocoses were up (no screening)
Dare I say it: screening works
OP0274 #EULAR2022 @RheumNow
David Liew drdavidliew ( View Tweet)
MACE events no diff in German RA Rabbit registry of only humans shows #baricitinib and #tofacitinib vs #TNFis @RheumNow @eular_org #EULAR2022 OP0135 https://t.co/O8iOA7jpal
Janet Pope Janetbirdope ( View Tweet)
Risk of haematological malignancy in PsA
Nordic cohorts
*40 events, IR 67/100 000 person-years
*NO difference between PsA bionaive and TNFi treated
BUT *⬆️ in PsA vs. matched controls
*no difference between myeloid and lymphoid malignancies.
OP0257 #EULAR2022 @RheumNow https://t.co/oIojobgDP3
Aurelie Najm AurelieRheumo ( View Tweet)
Montastruc et al. VigiBase study of CV and VTE events in JAKi vs TNFi. >270000 events. DECREASE in MACE ROR=0.87 [95%CI 0.80-0.95]. INCREASE in DVT: ROR=3.99 [3.15-5.04], PE: ROR=3.47 [2.90-4.13] @RheumNow #EULAR2022 OP0268 https://t.co/lUin7ciXWt https://t.co/Gr4Kvd8F7R
Links:
Richard Conway RichardPAConway ( View Tweet)
MACE in JAKi vs TNFi: did spontaneous reporting pharmacovigilance pick it?
Vigibase: MACE (really MI) & VTE signals there before the scare
Always chance regulatory warnings cause stimulated reporting
but signal here was clear before RCT-driven alerts
OP0268 #EULAR2022 @RheumNow https://t.co/hTJD1gMgyy
David Liew drdavidliew ( View Tweet)
Video: Further Considerations of the ORAL Surveillance Study
Further Considerations of ORAL Surveillance Study - this week there are new analyses and sub-analyses that further explain findings and who this data applies to. #EULAR2022
https://t.co/a2XKthtMbs https://t.co/kYNS1AesHT
Links:
Dr. John Cush RheumNow ( View Tweet)
Real world study of over 6500 patients from a French Health Insurance database by Pina Vegas et al showed higher persistence of IL17i than TNFi for PsA and PsO. IL17i had better persistence than IL12/23 for PsA and no difference for PsO over 3 years #EULAR2022 @RheumNow POS0075 https://t.co/hBI8tgb5Jb
Dr. Antoni Chan synovialjoints ( View Tweet)
