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Shifting Trends in Initial RA Treatment Approaches
A recent study by Sparks et al reveals evolving trends in DMARD usage for rheumatoid arthritis over two decades in the United States. This retrospective analysis evaluated 407,728 DMARD initiation episodes among 229,365 unique patients from 2001 to 2021.
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🚨Therapeutic target in PsO?
Abst#0067 from Cleveland Clinic evaluated pts w/ PsO at high risk for PsA (HR-PsO).
- HR-PsO: ⬆️percentage in migratory dendritic cells with elevated expression of CXCR4.
- Migratory effect ⬇️ after selective CXCR4 inhibitor. #ACR24 @ElaineHusniMD… https://t.co/nVoAThUxi1 https://t.co/8d1K3nkttI
Links:
Adela Castro AdelaCastro222 ( View Tweet)
Abstract 0587: Among PsA patients (bDMARD-naive & TNF non-responders) treated with Bimekizumab, better disease control was linked to improved work productivity, including ↓ work impairment, ↓ presenteeism, and ↓ activity impairment. #ACR24 @RheumNow https://t.co/sZBjJ9lk39
Akhil Sood MD AkhilSoodMD ( View Tweet)
Lots of ‘CARTS’, not enough ‘work horses’!
There are now ~40 CAR-T protocols in #lupus incl many presentations at #ACR24
-most are uncontrolled
-selection of pts is key.
We need a pathway forward for reg approval & guidelines for studies!
@RheumNow @ACRheum 18abst #OOO4 https://t.co/Mckwvn3Ffn
Janet Pope Janetbirdope ( View Tweet)
Small but useful open label RCT of MMF vs CYC vs TAC in SLE nephritis
Surprisingly similar rates of remission at week 24... suggests TAC could be an option for induction?
#ACR24 @RheumNow Abstr#0670 https://t.co/rO0ufturHW
Links:
Mike Putman EBRheum ( View Tweet)
Upadacitinib (UPA), a new oral treatment option for GCA? Dr. Peter Merkel discusses SELECT-GCA.
UPA15 + 26-week GC taper >> PBO with a 52-week GC taper for GCA remission.
#ACR24 #ACRBest @RheumNow ABST#0770 https://t.co/UbQLVA8X7r
Jiha Lee JihaRheum ( View Tweet)
It's been a wild ride over the last 20 years of RA b/tsDMARDs, and fascinating to see how our prescribing habits have changed over that time.
MarketScan data tell a story of fashion and fame. What will the next 20 years be like?
#ACR24 ABST0509 @jeffsparks @RheumNow https://t.co/wCcWgkHrvc
David Liew drdavidliew ( View Tweet)
Major update in tx for GCA beyond Toci
SELECT-GCA showed upadacitinib 15mg daily achieving higher rates of remission with SHORTER (26wk) steroid use compared to placebo (52wk)
No significant adverse safety signal w JAKi including MACE/malignancy
@RheumNow #ACR24 Abstract 0770 https://t.co/45D0Txed2N
Links:
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
GLP1ra is now part of GDMT, including pts without diabetes. The role of rheums in prescribing these remain to be seen. - Dr Weber #ACR24 @rheumnow @ACRheum https://t.co/U9XEhGBXBN
Links:
TheDaoIndex KDAO2011 ( View Tweet)
#0509
📊 RA DMARD Trends in US (2001-2021)
🧑🤝🧑 407,728 DMARD starts in 229,365 patients
📉 csDMARD use fell (79.7% → 54.7%)
‼️Methotrexate dropped 29% → 15%
📈 bDMARDs (20.3% →33.1%),tsDMARDs (0.1% → 12.2%) both ⬆️⬆️
💊Biosimilar uptake low
#ACR24 @RheumNow @jeffsparks https://t.co/JepaWj7azY
Caoilfhionn Connolly CaoilfhionnMD ( View Tweet)
The TAPIR Trial on GPA shows higher (15.5%) relapse in the 0 mg prednisone arm vs. 4.2% in the 5 mg arm (OR 4.22), but does not impact PROs. Key finding: benefit of 5 mg/day seen only in non-rituximab regimens (20% vs. 2.6%, OR 9.50). Abstr#0774 Plenary 1 @RheumNow #ACR24… https://t.co/5DjW5Zwh0J https://t.co/UnsVPzJfs6
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Antoni Chan MD (Prof) synovialjoints ( View Tweet)
SELECT-GCA: Upa in GCA Merkel Upa 15 mg v 7.5 v PBO w slower GC taper 70% new onset, 30% relapse. Few prev on IL6 Primary endpt: sustained remission at w52- UPA 15 mg beats PBO (p=0.0019) 34% relapse in UPA vs 60% PBO Less steroids, longer time to flare @RheumNow #ACR24 #ACRBest https://t.co/1OV2889Ny0
Links:
Eric Dein ericdeinmd ( View Tweet)
#ACR24 Year in Review: 💡GLP1i significantly decreased knee OA pain over time (or was it the wt loss itself?🤨) 💡CD19 CAR T-Cell therapy has potential to treat/cure many autoimmune diseases (are risks and $ worth the benefit?) 💡 High risk of CV events within 30 days of gout… https://t.co/XF63zr6lk4 https://t.co/oRNri66Il9
Links:
Adela Castro AdelaCastro222 ( View Tweet)
EGPA: To RTX or not to RTX?
French MAINRITSEG trial underway to determine utility of RTX vs. AZA maintenance therapy
Huge anticipation for these results, hopefully next year!
#ACR24 @RheumNow https://t.co/POelLpirrI
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
Hot off the racks:
The MITIGATE trial is the 1st RCT for IgG4-RD showing that Inebilizumab significantly reduced flare rates vs PbO by depleting CD19-targeted B cells
Game changer?
Year in review.
@RheumNow #ACR24 @rheumarhyme @marklagacmd @idatan @ljdado https://t.co/CZvdrymIyr
Links:
sheila RHEUMarampa ( View Tweet)
Treatment alert for Sjogrens
TWINSS study:
Iscalimab CD40/CD40L monoclonal Ab:
Improves disease activity
Also helps fatigue and sicca, not pain
Dazodalibep - CD40L antagonist also reduce symptoms/disease activity
Year in Review #ACR24 Pillinger
@RheumNow https://t.co/WjHuEpm9XW
Links:
Eric Dein ericdeinmd ( View Tweet)
Year in review:
The MANDARA trial showed benralizumab was non-inferior to mepolizumab for #EGPA
@RheumNow #ACR24 @rheumarhyme @doktora_ging https://t.co/k5azGQOECB
Links:
sheila RHEUMarampa ( View Tweet)
Looking forward to this Plenary - upadacitinib vs plbo in GCA
Similar to GiACTA, 26wk taper w/UPA better than 52wk taper w/PLBO. Too small for safety, but no new rsks
Strong argument for DMARDs upfront in GCA... but doesn't help with which 😉
#ACR24 @RheumNow Abstr#0770 https://t.co/MZY4QUazhI
Links:
Mike Putman EBRheum ( View Tweet)
MANDARA
Mepolizumab v benralizumab for EGPA
BEN is non-inferior
Secondary outcomes- less eosinophils and more pts completely off GCs
Now approved for EGPA
Year in Review #ACR24 Pillinger
@RheumNow https://t.co/ThLziABvzu
Eric Dein ericdeinmd ( View Tweet)
Abatacept for GPA?
Tx with Abacept did NOT significantly reduce rates of treatment failure compared to GC + PBO (background DMARD allowed) in non-severe, relapsing GPA
Continued need for tx options in non-severe relapsing dz
@RheumNow #ACR24 Abstract #0823 https://t.co/7GfprUzoL7
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
