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ACR 2025 began today in Chicago with throngs of rheumatologists, fellows, ARP members, APPs and pharma folk taking to the meeting halls and rooms for tons of novel content.
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The RheumNow Faculty have run through day one at ACR25 and come with a few of their favorites - some what you expected but some of these are gems.
Antoni Chan MD (Prof)
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In a cohort of 269,304 IBD patients, NSAID use showed a small increase in IBD-related hospitalisation (HR 1.08), meeting non-inferiority threshold (HR <1.2). No risk in UC (HR 0.96); modest risk in Crohn’s (HR 1.16). Relooks at the current paradigm of blanket NSAID avoidance in https://t.co/O8MWg1BP50
Mike Putman
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56 pts w/tracheobronchial stenosis in GPA, highly frustrating disease manifestation
Not surprising to see severe dx & prior intralesional tx assoc with incidence (ie necessity) of tracheal dilation
Leflunomide protective? Have others seen this?
#ACR @RheumNow Abstr#1596 https://t.co/djJXnAkxnv
sheila
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In a prespecified exploratory analysis of REGENCY trial data by DrRovin et al,
Bet. wks 24 and 76:
Obinutuzumab ⬇️ LN flares vs. PBO (HR 0.44; p=0.0074)
Pts on Obi had less unfavorable kidney outcomes vs. PBO (HR 0.37; p=0.0039)
Addtl tx option for LN
#ACR25 @RheumNow Abs1521 https://t.co/N5K9Nzh71E
Richard Conway
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Simko et al. 6-monthly vs 3-monthly MTX lab monitoring. 3821 patients. Appears to be no difference. Potential for significant cost-savings and reduced burden to patients. @RheumNow #ACR25 Abstr#1370 #ACRbest https://t.co/G3tNQq8qXT
Brian Jaros, MD
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Infection data from SELECT-GCA:
Glucocorticoids seem to drive overall infectious risk
UPA use associated with higher zoster - vaccinate!!
@RheumNow #ACR25 Abst# 0895 https://t.co/ueVbFPxG0Q
Mike Putman
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Post Hoc analysis from SELECT-GCA
Increased rate of herpes zoster for 26wk steroid-UPA 15mg (7.3% vs 4.2% 52wk steroid-plbo) but lower rate of SERIOUS infections (7.9% vs 12.7% 52wk steroid-plbo)
Zoster risk is real; steroids are the bigger problem
@Rheumnow #ACR25 Abstr#0895 https://t.co/IKzO2J4hLH
Brian Jaros, MD
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Concerns using dupilumab in EGPA due to secondary eosinophilia
What about when combined with IL-5 therapy?
16 pt on dupi + IL5 agent
- if dupi alone caused eosinophilia -> quelled by IL-5
- no eosinophilia when dupi added to IL-5
- effective but slow
@RheumNow #ACR25 Abst 1605
Bella Mehta
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Liraglutide had decreased synovial inflammation and fibrosis in mouse models, however dexamethasone didnt have changes in fibrosis scores
Abst#1734 #ACR25 @RheumNow https://t.co/O4JYGtDD5N
Mike Putman
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Analysis from FVSG identified 36pts with anti-rituximab antibodies
In AAV, lookout for this in pts who are MPO+ & w/higher CD19 at 6 mos. Worse relapse free survival in both AAV & CRYO!
@TerrierBen can you share the prevalence of these abs?
#ACR25 @RheumNow #ACRBest abstr#1604 https://t.co/Nyx6JxbvUk
Brian Jaros, MD
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Ultra-low dose (ULD) RTX in AAV maintenance
200mg q6 mo vs. 500mg q6 mo interim analysis
No major difference in infection risk or hypogammaglobulinemia thus far but both doses appeared similarly efficacious
#ACR25 @rheumnow Abst 1609 https://t.co/ZGYNVGY3dr
Richard Conway
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NEREA registry study on mortality in progressive pulmonary fibrosis in SARD-ILD. 158 patients. Median survival 7.8 years. DMARD use associated improved mortality. @RheumNow #ACR25 Abstr#1024 https://t.co/rK1caGi2r4
David Liew
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In this MTX+PNL vs TCZ+PNL in GCA study, we saw 5 pts on MTX+PNL get PJP, very surprising.
@EBRheum asked what I knew/hoped he’d ask: why did this happen?
PJP is v rare in GCA
(https://t.co/oPN0dpvG8Q) & with MTX in other diseases.
Worth interrogation!
#ACR25 ABST0891 @RheumNow https://t.co/rsbScryIFR
David Liew
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Is MTX worth anything in GCA?
METOGiA: MTX 52w vs TCZ 52w for GCA
MTX didn’t achieve non-inferiority to TCZ, but:
- clearly it does something
- continue both >1y: after MTX/TCZ therapy ended, they ended up with same relapse-free survival, cumulative GC
#ACR25 ABST0891 @RheumNow https://t.co/WvvkHKIXuQ
Brian Jaros, MD
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Open-label MTX vs. Toci in GCA in METOGiA
Wk 78:
37% w/o relapse in MTX arm
46% w/o relapse in Toci arm
MTX was NOT non-inferior to Toci
Toci superior in 2ndary endpoints
Cumulative doses GC not significantly different
#ACR25 #ACRBest @RheumNow Abst 0891 https://t.co/lCaP4EdJ9C
Mike Putman
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Open label noninferiority RCT "METOGiA" in GCA
TCZ improved relapse free survival (83% vs 67% MTX) & pred free remission (81% vs 61% MTX) wk 52. Ignore the weird primary endpt at week 78
Everyone also got pred; are we sure MTX works at all?
@RheumNow #ACR25 #ACRBest Abstr#0891 https://t.co/i48JBnawB7
Dr. John Cush
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SGLT-2 inhibitors and the prevention of autoimmune rheumatic disease
SGLT-2 inhibitors offer benefits beyond glycemic control, such as cardioprotective and nephroprotective effects, and modest weight loss. A recent study also suggests they may have immunomodulatory effects and https://t.co/grsgHFQic5
Brian Jaros, MD
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Is tocilizumab equally effective in ischemic vs. non-ischemic GCA?
Ischemic = vision, jaw claudication, or CVA
Remission at 6 mo higher in non-ischemic group then with equalization at month 12
No major difference in GCs at month 12
@RheumNow #ACR25 #Abst0739 https://t.co/OeYggSQYx8
Brian Jaros, MD
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2 year extension data from SELECT-GCA:
Patients in remission who remained on upadacitinib 15mg daily after 1 year had 90% reduced risk of flare compared to those who switched to placebo
Higher rates zoster, CK elevation in UPA group
#ACR25 @RheumNow #ACRBest https://t.co/jf8Dh2wCBj
