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EULAR 2022 – Day 1 Report
It’s good to be back into full, big meeting mode.
Highlights included a EULAR Recommendation Session, where updated guidelines were presented for the management of a) ANCA-associated Vasculitis, b) ASAS/EULAR recommendations for axSpA and c) RA. Here are a few of my favorites from Day 1.
RNL 2022: Rheumatoid Arthritis - Best Management
This week's Tuesday Night Rheumatology, hosted by Dr. Jack Cush, featured highlights from the 2022 RheumNow Live Rheumatoid Arthritis - Best Management Pod, followed by a lively audience Q & A. Lectures featured:
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Study of 2.9k offspring exposed to adalimumab, infliximab, golimumab during pregnancy, as compared to etanercept and certolizumab showed an adjusted hazard ratio for serious infections of 1.20 (CI 0.54, 2.64).
@RheumNow #EULAR2022 ABST#OP0130
Robert B Chao, MD doctorRBC ( View Tweet)
GM-CSF increased in patients with active ankylosing spondylitis, correlates with disease activity, not duration. TNFi does not affect GM-CSF levels. Could explain efficacy of JAKinibs and response for residual inflammation during TNF blockade.
@RheumNow #EULAR2022 ABST#OP0107
Robert B Chao, MD doctorRBC ( View Tweet)
Congenital malformations after intra-uterine exposure to non-TNFi when compared to certolizumab showed vedolizumab and belimumab were associated with higher CMs. Vedolizumab showed specific CM pattern (corpus collosum agenesis).
@RheumNow #EULAR2022 ABST#OP0129 https://t.co/wgRlm9QLgW
Robert B Chao, MD doctorRBC ( View Tweet)
Sex differences in PsA disease expression and treatment. Treatment efficacy and retention rates lower among female PsA pts initiating first TNFi. Women presented with higher 28 TJC and PRO at baseline as well..
@RheumNow #EULAR2022 ABST#POS0077 https://t.co/yV11kCN2bZ
Robert B Chao, MD doctorRBC ( View Tweet)
Baseline molecular differences noted in PsA patients who are TNFi naive and incomplete responders. Elevated IL-22 expression may suggest increased involvement of IL-23 pathway in TNF-IR pts. @RheumNow #EULAR2022 ABST#POS0074
Robert B Chao, MD doctorRBC ( View Tweet)
Large French study of over 23k patients with either PsA or PsO showed a longer persistence (time of initiation to discontinuation) in those who took IL-17i vs. TNFi for PsA and PsO pts. IL-17i longer than IL-12/23i in PsA pts.
@RheumNow #EULAR2022 ABST#POS0075 https://t.co/rH1g4fPUYC
Robert B Chao, MD doctorRBC ( View Tweet)
Flatman et al. Serious infections in babies born to women using TNFi during pregnancy. 2902 babies. Adjusted HR 1.20 (0.54-2.64) for agents with high vs low placental transfer. @RheumNow #EULAR2022 OP0130 https://t.co/oaW7wDPxva
Links:
Richard Conway RichardPAConway ( View Tweet)
#EULAR2022 ASAS/EULAR AxSpA Recs
⭐️Last: 2016
▶️All: education, exercise, 🚭
▶️❌csDMARD for axial disease
▶️TNF/IL17 (or JAK) with high disease: ASDAS>/=2.1
▶️Monoclonal TNF for uveitis/IBD, high PsO: IL-17
▶️Sustained remission: tapering of bDMARD "can be considered"
@RheumNow https://t.co/3yYU0Vb37r
Eric Dein ericdeinmd ( View Tweet)
No need to switch TNFi during pregnancy. Study compared high placental vs. low placental transfer TNFi- no sig difference for SIE in childhood. Dr. L Flatman comparing different TNFi in pregnancy: 26,000 offsprings #EULAR2022 @rheumnow OP0130 https://t.co/IF5hepQoHc
TheDaoIndex KDAO2011 ( View Tweet)
#EULAR2022 OP0135:
German RABBIT 🐇 Registry:
⭐️ Observational, 46% Tofa, 54% Bari
No increased rate of CVD in JAK vs TNF inhibitor
🚨Unlike the ORAL Surveillance
@RheumNow https://t.co/O4IXg22Ybc
Eric Dein ericdeinmd ( View Tweet)
RABBIT registry and MACE in RA
No difference between
*JAKi (Tofa and Bari) and *TNFi in both unselected and high CV risks patients.
🧨 different than ORAL surveillance
but Observational and overall Low incidence (28 events).
#EULAR2022 @RheumNow OP0135 https://t.co/o8rngHrwQF
Aurelie Najm AurelieRheumo ( View Tweet)
Sex differences may affect the response to first line TNFi in AxSpA. Hellamund et al EuroSpA study showed the TNFi 6/12/24 month retention rate was lower in females (58%) compared to males (72%). Females had lower CRP level and higher PROs at baseline #EULAR2022 @RheumNow OP0020 https://t.co/ANgRYMxpat
Dr. Antoni Chan synovialjoints ( View Tweet)
Cdn cohort of #PsA and CV events - u risk factors were associated with MACE and NSAIDS ⬆️ risk and TNFi ⬇️risk and poor HAQ⬆️ risk. #OP0030 @RheumNow @eular_org Too small events, lipids often absent and spanning 30+ yrs.
Janet Pope Janetbirdope ( View Tweet)
Once we add adalimumab in MTX-IR RA, can we dial down MTX & still keep control?
New data - now in East Asian pts (with already low MTX) says often yes, without ⬆️ADAb.
Obviously RA control 1st/2nd/3rd, but prob doesn’t have to be MTX 20 forever in everyone #EULAR2022 @RheumNow https://t.co/aZ0bsgY7dC
David Liew drdavidliew ( View Tweet)
Hellamand et al. Sex differences in first TNFi response in AxSpA. Treatment efficacy (RR 0.85) and retention (58% vs 72% month 24) rates lower in females. @RheumNow #EULAR2022 OP0020 https://t.co/2IL88K7q40 https://t.co/hSJds5EJFK
Links:
Richard Conway RichardPAConway ( View Tweet)
Combined Nordic registry data on demyelination and inflammatory neuropathy with TNFi. Demyelination 2-3 times higher in SpA vs RA. No difference between ETN and monoclonals. @RheumNow #EULAR2022 OP0060 https://t.co/SK9s7aVaZk https://t.co/hZ5VaoTe4X
Links:
Richard Conway RichardPAConway ( View Tweet)
Combined nordic registers study: 🧠 demyelinating and inflammatory neuropathies in 50000+ patients starting TNFi
📍DML SpA > RA
📍INP SpA = RA
📍ETA = Other anti TNFi
But no csDMARDs control group
OP0060 #EULAR2022 @RheumNow https://t.co/LYqUW22rMg
Aurelie Najm AurelieRheumo ( View Tweet)
Combination tx of NSAIDs and TNFi (celecoxib and golimumab) did not show significant superiority compared to TNFi alone in slowing radiographic progression for treatment of radiographic axSpA. There was a numerical reduction however.
#EULAR2022 @RheumNow #ABSTOP0018 https://t.co/gUZAwd92dK
Robert B Chao, MD doctorRBC ( View Tweet)
