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Here are 3 abstracts that caught my eye on Day 2 at ACR25. Notably these have takeaway messages that should support your current practices.
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After a full day at the Chicago Convention center the RheumNow faculty have posted some of their favorite reports included these that they labeled as being the "best' of day 2.
Richard Conway
Tweet
Zavada et al. 52 patients. bDMARD therapy improves sexual function at 6 months in r-axSpA. Improvements in function, desire, satisfaction in those with baseline erectile dysfunction @RheumNow #ACR25 Abstr#2346 https://t.co/IUMGCFnXZh
Richard Conway
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Konsta et al. Adding NSAID to TNF inhibits spinal but not hip radiograpic progress. 262 patients, TNF+NSAID 100, TNF alone 162. New syndesmophytes 36% vs 58%. ΔmSASSS-score/year 0.1 vs 0.7. No effect on progression of hip radiographs. @RheumNow #ACR25 Abstr#2359 #ACRBest https://t.co/k9j2M2E3ze
Akhil Sood MD, MS
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Paging the pharmacist
Abstract 1973: Dedicated clinic pharmacist -> benefits
Tasks included:
🔹 74% PA support
🔹 55% patient education
🔹 40% medication management
~50% pts had clinically meaningful improvement
Providers report ↑ care quality & ↓ admin burden
@RheumNow #ACR25
Brian Jaros, MD
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MAINRITSEG: RTX vs. AZA for maintenance in EGPA
RTX not superior in primary remission outcome
RTX favored in secondary outcome of remission with pred <4mg daily
Limitation: only ~50% pt with FFS 1+
@RheumNow #ACR25 Abst 1765 https://t.co/dh5ZWCT12T
Richard Conway
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Girolami et al. VA study. Safety of DMARDs in RA following melanoma. 644 patients. 3 year all cause mortality. No significant difference, but graph sure looks like b/tsDMARDs are better. No melanoma specific mortality/recurrence data however. @RheumNow #ACR25 Abstr#2237 #ACRBest https://t.co/IN4LDkioT7
Brian Jaros, MD
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HCQ weight-based dosing: out
HCQ whole blood monitoring: in
Whole blood levels more precisely balance risks of SLE flare (under-dosing) vs. toxicitiy (over-dosing)
Many pt on <5 mg/kg had supra-therapeutic blood levels with risk for toxicity
@RheumNow #ACR25 #ACRBest Abst 1722 https://t.co/qIbACxAW39
Janet Pope
Tweet
Passive transfer of Ab can occur w #IVIg
#Ab can occur from IVIg passive transfer incl HepB
IVIg - if pt has #cryoglobulins
👇
Can precipitate severe #cryo flare
#ClinicalPearl
Secrets & Pearls session
#ACR25 @RheumNow @ACRheum https://t.co/tTaSuVy1yQ
sheila
Tweet
Pooled data fr diff SLE cohorts by Dr SGarg et al were evaluated to determine an upper threshold tx range of HCQ
750-1150 ng/mL: safe & effective HCQ levels
>1150ng/mL-supratx, no added tx benefit
CKD st >/=3: 2x ⬆️odds of toxic hcq levels
#ACR25 @RheumNow Abs1722 #ACRBest https://t.co/RFx1VO0bov
Mrinalini Dey
Tweet
3rd plenary session!
#1722 Defining safe HCQ levels in SLE: whole-blood 750-1150ng/mL= therapeutic range; >1150ng/mL ➡️ ~2× toxicity risk; <750ng/mL ➡️ higher flare risk
CKD ≥3 increases odds of supratherapeutic levels
New era of precision monitoring in SLE?
@RheumNow #ACR25
Mike Putman
Tweet
Plenary 3, HCQ blood levels in SLE
HCQ level > 1150: 1.9x risk of HCQ toxicity
HCQ level < 750: 1.4x risk of active SLE
HCQ dose < 5mg/kg: 1.9x risk active SLE
My take home? Blindly reducing dose to <5mg/kg is BAD; use levels instead!
@RheumNow #ACRBest #ACR25 Abstr1722 https://t.co/UCBPAKAyon
Md Yuzaiful Md Yusof
Tweet
#ACR25 Please find my video and take on Abstr#0803. Should we use Belimumab before- or after a trial of concentional immunosuppressant in #SLE? @RheumNow
https://t.co/ExIvrdJXw5 https://t.co/AVb5ohWwXZ
Md Yuzaiful Md Yusof
Tweet
#ACR25 Abstr#0855 Five extra patients were added to complete IMPACT Open Label Phase 2 trial of add-on Certolizumab in APS women + LAC+ve. Results stood: primary endpoint was met (adverse pregnancy outcome=19.6%; lower than 20% expected). Significant enough to adopt @RheumNow https://t.co/zhFVGYXiaU
David Liew
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So who with inflamm arthralgias might benefit from abatacept, in terms of delaying RA onset?
ALTO study (APIPPRA continuation)
1y abatacept then follow
If autoAb x5 (RF, ACPA IgG, IgA, anti-CarP, AAPA): sustained delay of RA
If not: benefit only on Rx
#ACR25 ABST1678 @RheumNow https://t.co/3Pc5ZLzVf6
Aurelie Najm
Tweet
Early TNFi treatment leads to
-Less D2T at 5 yrs
-More sustained remission at 10yrs
-Less bDMARD escalation at 5yrs
-More DMARD free remission at 5yrs and 10 yrs
-20% reduction annual healths costs
-11 mo delay in ttmt escalation
Safety data were not presented
#ACR25 https://t.co/jPMGUGPtqP
David Liew
Tweet
In case you missed it in @ACR_Journals: HCQ for 1y does not prevent RA development in people with CCP3 >2x ULN, either:
- during 1y of treatment
- in 2y follow-up
https://t.co/gtzNiSmutb
but StopRA will give us plenty of insights - data is never wasted
#ACR25 ABST1674 @RheumNow https://t.co/DDZib5VGtX
Akhil Sood MD, MS
Tweet
In the IMPACT trial (Abs 0855), certolizumab met its primary endpoint: <20% had an adverse pregnancy outcome (APO) among females w/ APS & prior APO.
✅ 94% live births, all survived to discharge
📈 Median GA: 37 wks (no APO) vs 31 wks (APO)
@RheumNow #ACR25
Aurelie Najm
Tweet
Did we need a 2nd Interception RCT of HCQ in Pre-RA?
Unsure but in any case, it does not work either
STOPRA CCP3+>=2 ind 71 HCQ and 74 PBO
36 months RA conversion
Dr Deane's take: "probably wrong drug rather than wrong timing"
#ACR25 @RheumNow #ABSTRACT1674 https://t.co/jysdo8iz7v
Richard Conway
Tweet
Like PEXIVAS steroid taper, this is something we need an online resource to check each time. Its complicated, but feels "right". @RheumNow #ACR25 https://t.co/QAgSQB9XMQ
