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Novel treatment options for Giant Cell Arteritis
Giant cell arteritis is associated with significant treatment related morbidity due to the dependence on glucocorticoids as a treatment option. After sixty years of therapeutic stagnation, these are exciting times in the management of GCA. At this year's ACR Convergence meeting, encouraging data will be presented on options for GCA.
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Management of Immune-Related Adverse Events - ASCO Guideline
The American Society of Clinical Oncology, Inc (ASCO) has updated its guidelines and recommendations for the management of immune-related adverse events (irAEs) in patients treated with immune checkpoint inhibitor (ICPi) therapy. Below are select statements from this guideline.
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@SattuiSEMD presents @rheum_covid data on COVID-19 outcomes in vasculitis/PMR. High rates of severe outcomes, particularly for AAV and GCA (mortality >20% for both). Multiple factors associated with outcomes (see below). Abstr#952 #ACR21 @RheumNow #ACRBest https://t.co/0lw1QhuJct
Richard Conway RichardPAConway ( View Tweet)
So important for our systemic vasculitis & PMR pts, @rheum_covid data highlighting the outsized COVID-19 risks they face.
Thanks @SattuiSEMD @RichardPAConway @EBRheum in particular for driving forward this badly needed work!
#ACR21 ABST0952 @RheumNow https://t.co/L7XS9OblxI https://t.co/LYxR1WUlhM
David Liew drdavidliew ( View Tweet)
#ACR21 #Abstr0437 OK, so RTX affects #COVID vaccine but some pts need RTX. Factors predicting response to vaccine:
RA vs AAV/IIM
Higher IgG
Longer time-to-RTX
Lower RTX courses Number.
Prediction Calculator is developed but need ext. validation #RheumNow https://t.co/iXSaGQ76hS https://t.co/WQAV3GRPBz
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
Dr. Marvisi presented a case: refractory MPA relapsed w/prednisone < 25 mg/day. Genetic studies c/w VEXAS. Is MPA/vasculitis part of VEXAS? The experts say: Maybe- VEXAS is such a new entity, there may be a common pathway (e.g NFkB affected by ubiquination, IL-6 role) #ACR21 https://t.co/kEOsruJ8DE
TheDaoIndex KDAO2011 ( View Tweet)
In GCA, why might you target GM-CSF over IL-6?
Entirely plausible TCZ might be leaving some Th1 stones unturned, esp:
vascular remodelling
downreg pathways
Transcriptomics from toci/mavri-treated TAB show it's plausible beyond just theory...
Cid group #ACR21 ABST0506 @RheumNow https://t.co/YephlzHOdj
David Liew drdavidliew ( View Tweet)
Do you use ANCA to change Rx in prevalent GPA pts? GS401 #ACR21 @RheumNow
Janet Pope Janetbirdope ( View Tweet)
Dr De Miguel on subclinical large vessel vasculitis in PMR. US assessment. 22% had subclinical GCA. 90% LVV, 10% cranial GCA. Abstr#0466 #ACR21 @RheumNow https://t.co/PDCynMAigi
Richard Conway RichardPAConway ( View Tweet)
Our latest article on outcomes of patients with vasculitis and PMR and COVID-19 published in @TheLancetRheum . @rheum_covid project with co-leads @SattuiSEMD and @EBRheum . https://t.co/8NTAafdYRA
Richard Conway RichardPAConway ( View Tweet)
📌Pre-Test Probability in GCA
ESR/CRP can be normal:
~10% of pts at diagnosis
-20-40% at time or relapse
#ACR21 #ACRAmbassador #RheumTwitter https://t.co/kenaD31pYa
Nina Couette RheumDr_Nina ( View Tweet)
Dr Doliner @zach_wallace_md on ILD in AAV. ILD in 13% - of which 76% fibrotic. UIP most common. Most MPO+, but also rarely seen with PR3+. 47% ⬆️ risk of death. Abstr#0430 #ACR21 @RheumNow https://t.co/6MnxqW92bz
Richard Conway RichardPAConway ( View Tweet)
Dr O'Brien on co-existent AAV and RA. Not something I'm used to seeing, but maybe we need to think about it more? 25 cases with RA+AAV, 52 with RA + ANCA but no AAV, not sure what the denominator is here though. Abstr#0428 #ACR21 @RheumNow @profgayecunnane https://t.co/fN3BRpc7UJ
Richard Conway RichardPAConway ( View Tweet)
How much ritux for AAV maintenance?
Ever since we started using it, no-one's been sure.
If absolute B cell depletion is your goal, @VUMCRheum data suggest >3.3mg/d is safest for that
500mg q6m = 2.7 mg/d
500mg q4m = 4.1 mg/d
1000mg q6m = 5.5mg/d
#ACR21 ABST0416 @RheumNow https://t.co/mYAgKhHT7j
David Liew drdavidliew ( View Tweet)
Dr Springer on pharmacological response of RTX in ANCA-vasculitis. Suggest that 500mg every 6 months may not achieve sufficient B cell depletion in all. What are the clinical implications? Is anyone dosing 500mg as standard? Abstr#0416 #ACR21 @RheumNow https://t.co/w36hSYbW1B
Richard Conway RichardPAConway ( View Tweet)
In ANCA-associated vasculitis, does reverse seroconverting (ANCA+➡️ANCA-) make a difference?
relapse - no
ESRD - no
death - no
Don't measure serial ANCAs for prognosis
(no diff MPO/PR3, RTX/CYC)
target trial emulation @BrighamWomens @MGHrheumatology #ACR21 ABST0419 @RheumNow https://t.co/rLkTY0ul8f
David Liew drdavidliew ( View Tweet)
ADVOCATE - Avacopan: C5a inhibitor, promising new therapy for ANCA vasculitis as possible steroid sparing therapy. Non-inferior outcome of remission, sustained remission, relapse wo signif adverse effects. @rheumnow #ACR21 https://t.co/m5zexRpeS8
Eric Dein ericdeinmd ( View Tweet)
#ACR21 #YearinReview
Avacopan: The game changer for ANCA #vasculitis?🧐
🔅Remission at wk 26: Avacopan non-inferior to Pred (72.3% vs. 70.1%, p<0.001)
🔅Sustained remission at wk 56: Avacopan non-inferior to Pred (65.7% vs. 54.9%, p<0.001)
@RheumNow
https://t.co/CpPYVvRoMR https://t.co/QnsZIUQ0uu
Links:
sheila RHEUMarampa ( View Tweet)
Dr. K Costenbader #ACR21 #YearinReview add-ons Rx:
👉Avacopan for AAV: new oral C5a inh allowed for remission & prevention of relapse, aggressive pred taper https://t.co/39V3LLOYKZ
TheDaoIndex KDAO2011 ( View Tweet)
Rheumatic pts admitted to ICU, #SLE is most common & Sepsis most common reason. 80 ARD pts adm to ICU: Dx were SLE (42%), RA (26%), vasculitis (12%) FOR Sepsis (31%), (10%) CHF (10%). 20% died in ICU, 5% 30d after ICU, 7.5% w/in 1 yr https://t.co/lX0m3vOukI
Links:
Dr. John Cush RheumNow ( View Tweet)
