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An update on JAK inhibitors and cardiovascular risks
In the last 2 years, there has been more caution and vigilance with the use of JAK inhibitors in the treatment of rheumatoid arthritis due to the risk of CV events, including MACE and VTE. The ORAL surveillance study, a post-approval safety study conducted in RA patients aged ≥50 years with ≥1 CV risk factor, has resulted in increased caution and greater emphasis on assessment of MACE and VTE risks in patients starting JAK inhibitors.
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ILD in RA and PsA
Interstitial lung disease (ILD) is a severe extra articular manifestation of RA, with limited treatment strategies and poor prognosis.
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Medication adherence in #lupus - assessed using Optum administrative database 14 yrs. 12510 pts. Median copays were less than $ 10. Black and hispanics had significantly lower odds of adherence after adjusting for several SDOH! @rheumnow #EULAR2023 abst#AB0579 https://t.co/pO5tjzTPbz
Bella Mehta bella_mehta ( View Tweet)
Chinese study 43 axSpA pts Rx w/ Secukinumab-37 pts had HBV & 16% (6) reactivated HBV after mean 9 mos of SEC (5 w/ chronic HBV, 1 occult HBV). 2 pts chronic HBV reactivated despite anti-HBV prophylaxis. 6 axSpA w/ LTBI - none had TB on SEC https://t.co/o4gA9mcD2R https://t.co/XKwp2z9U3K
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Dr. John Cush RheumNow ( View Tweet)
Randomized double blind, placebo controlled MTX trial in inflammatory #handOA - pts with MrI detected synovitis. 97 pts 20mg MTX helped reduce pain and stiffness at 6 months. @rheumnow
#EULAR2023 abst#OP0070
Early work with some promise!
Bella Mehta bella_mehta ( View Tweet)
Interesting newer potential theraputics in #handOA discussed at #EULAR2023 - denosumab had clear structure modifying effects in erosive habd OA compared to placebo. Monocentric, placebo controlled, doubke blind phase 2 study of 100 pts. @rheumnow abst#OP0071
Bella Mehta bella_mehta ( View Tweet)
Recruitment in clinical trials is tough in #lupus and #CTD. A #EULAR2023 study of 49 trials, 1909 records- in an unselected, real world cohort of #CTD pts, upto 50% would be excluded due to classification criteria or overlapping features etc! Abst#op0013 @RheumNow https://t.co/X3YuvgSVzo
Bella Mehta bella_mehta ( View Tweet)
Colchicine 0.5mg BID for 12 weeks in #HandOA did not relieve pain. Results from 186 pts- double blind placebo controlled, randomized. MCID on VAS of 15 was not achieved. Presented at #EULAR2023 today abst#op0073
@RheumNow
Bella Mehta bella_mehta ( View Tweet)
Metanalysis of 62 RCTs, 16 LTEs, 82 366 Pt-Yrs JAK exposure. JAKi malignancy incid rate = 1.15/100 PYs in RCTs (1.26/100PYs overall). Network meta-analyses show no diff betw JAK & PBO or MTX in NMSC, but signif increased malignancy risk (IRR 1.50) https://t.co/kk12pa17Nn https://t.co/qEcRatKRSf
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Dr. John Cush RheumNow ( View Tweet)
Swiss Clinical Quality Management cohort
1200+ PsA pts:
Overweight 27% & Obesity 37% PsA > 11% vs. 30% general pop
Obesity ⬆️ over time in males only
Socio economic status NOT associated w/ risk in PsA population vs. general pop
https://t.co/wLkZUuskZl OP0064 #EULAR23 @Rheumnow https://t.co/dYg0iGmLCy
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Aurelie Najm AurelieRheumo ( View Tweet)
Diagnosing spondylitis is a pain in the ‘butt’! #EULAR2023 OP0005 studied an inception cohort of incident chronic low back pain followed for 2 yrs. Of pts referred to #rheumatologist, 1/3 had dx of axSpA, but clinical features alone didn’t; imaging did. @RheumNow OP0005
Janet Pope Janetbirdope ( View Tweet)
ICYMI: The Biosimilar "Buy In"
In 2023, we are expecting 17 biosimilars in rheumatology. While some pharmaceutical company and payer contracts are still under negotiation, we need to start preparing ourselves and our patients.
https://t.co/U7YTH0Uodf https://t.co/PZelN4G5Jb
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Dr. John Cush RheumNow ( View Tweet)
A highlight at #EULAR2023 AI in predicting RA from MRI scans of hands and feet in patients with early onset arthritis or clinically suspect arthralgia. From 1,974 people, 651 went on to develop RA. The accuracies were close to expert level prediction, Li Y, Abst#OP0002 @RheumNow https://t.co/MP8yn18PWI
Dr. Antoni Chan synovialjoints ( View Tweet)
#EULAR2023 #OP0052 Could we predict renal flares in #lupus patients treated with Belimumab for non-renal purpose? Post-hoc analyses of 3 x RCTs showed predictors were:
- Current/former renal involvement
- high baseline proteinuria
- hypoalbuminaemia
- low C3
@RheumNow https://t.co/vylWCf0XNy
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
RheumNow’s expanded coverage of the #EULAR2023 annual meeting is sponsored in part by Bristol Myers Squibb. All content is chosen by RheumNow and its faculty.
Dr. John Cush RheumNow ( View Tweet)
Beydon et al., french registry study 255000+ RA patients 2010-2020
Increase ⬆️ overall malignancy by 20% vs. general pop
⬆️lung 40%, ENT 40%, cervix 80%, prostate 8%, melanoma 37%
Pancreatic cancer 10% less frequent in ♂
Breast 9% & Uterine body 23% less frequent in ♀
Aurelie Najm AurelieRheumo ( View Tweet)
So can computers beat humans in predicting RA from pre-RA arthralgia MRIs?
No, for now… but unsupervised they pick up the same culpable features we look for: bone marrow edema & tenosynovitis. Sometimes it’s nice when the machines tell us we’re right
#EULAR2023 OP0002 @RheumNow https://t.co/71Zo2JyC8d
David Liew drdavidliew ( View Tweet)
I swear it is muscle, Doctor!
GLORIA trial substudy
Pred 5 mg/day 2 years in RA pts >65yo:
Weight gain 1kg vs. PBO, no increase or redistribution of fat mass but augmentation in lean mass 💪
Probably explained by better disease control (although NS in study, small sample size)
Aurelie Najm AurelieRheumo ( View Tweet)
Mild correlation between fine motor hand skills and synovitis score grey scale and PD
However no correlation w/ TJC68/SJC66 https://t.co/ryCs21KRcB
Aurelie Najm AurelieRheumo ( View Tweet)
#EULAR2023 #OP0053 Baricitinib in non-renal #lupus were inconclusive. How about Renal #SLE?An RCT showed primary endpoint (=>50% reduction in proteinuria) was met more in Bari vs Cyclo at Wks12 & 24. Intriguing but need longer-term, composite endpoint and larger size! @RheumNow https://t.co/z3YJog6gTy
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
