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RIP to Glucocorticoids in GPA
For many years glucocorticoids were the mainstay of our treatment of granulomatosis with polyangiitis (GPA). The paradigm shifted with cyclophosphamide and then again with rituximab, and we used less steroids, but we still used lots. Avacopan teased the demise of steroids, but in the trial they, and now we, still use them. Glucocorticoids are our old trusty friend, our comfort blanket. But no more! Good riddance to the medication with the highest long-term adverse event burden that we use. Long-term glucocorticoids in GPA should now be a rarity. The reason for such exuberance is the TAPIR study presented by Dr. Peter Merkel at Saturday’s opening plenary session.
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Serrano-Combarro et al. Abatacept in RA-ILD. 343 patients. In 23.3% ILD progressed on abatacept. Is that good or bad? We need comparative studies! @RheumNow #ACR24 Abstr#0475 https://t.co/nUEDdjGguA https://t.co/sXEF72MafK
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Richard Conway RichardPAConway ( View Tweet)
Are you pts using cannabis?
In Canada - 20% reported using w/in past 2 years
Use for pain, sleep, anxiety
78% noted efficacy
Compare to another study said 57% stopped due to inefficacy, 28% AEs - very diff result
70% did not tell their doc
16S18 @BharatKumarMD
#ACR24 @RheumNow https://t.co/6NAECW5MJK
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Eric Dein ericdeinmd ( View Tweet)
Serrano-Combarro et al. Baricitinib in RA-ILD . 72 patient case series. PFTs in picture. HRCT stable/improved in 72% over 24 months. Dyspnoea stable/improved in 90%. @RheumNow #ACR24 Abstr#0476 https://t.co/aVI2kRZkMN https://t.co/4l5GKsFKtm
Links:
Richard Conway RichardPAConway ( View Tweet)
Medical cannabis in the USA today
Variation in state practice on recreational/medical/decriminalization
16S18 @BharatKumarMD
#ACR24 @RheumNow https://t.co/9Ex3lge6KO
Eric Dein ericdeinmd ( View Tweet)
PRO-SPIRIT trial data on 1192 PsA pts showed IL-17Ai seemed better than IL-12/23i and IL-23i improving cDAPSA at 3m and as effective as TNFi and JAKi. No much differences seen at 12m. Abst#0076 #ACR24 @RheumNow https://t.co/dScwsmkDOe
Adela Castro AdelaCastro222 ( View Tweet)
In the SPACE cohort, patients with chronic back pain suspected of axial spondyloarthritis often receive a diagnosis within 35 months from symptom onset. Key determinants for early diagnosis include HLA-B27 positivity and sacroiliitis on imaging. Early diagnosis can be a game… https://t.co/RrcrtRoMfL
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
#0584🔬Real-World PsA Study:Tofacitinib
➡️141 pts:47% mono,53% combo;~70% on Rx @ 6mo
➡️Similar ⬆️in disease outcomes (cDAPSA LDA: 31% mono vs 21% combo; MDA ~16%).
➡️No significant differences mono v combo outcomes
🩺Tofa effective in diverse PsA population
#ACR24 @RheumNow
Caoilfhionn Connolly CaoilfhionnMD ( View Tweet)
With many treatments for #PsA and #PsO, what are the prescribing trends?
Abstract 0604: TNF inhibitors remain the most common (~60%), but over the past 10 years, IL-17i use rose from 0.2% to 19%, and IL-23i from 0.1% to 39.7%! #ACR24 @RheumNow https://t.co/4TnCAkHfuY
Akhil Sood MD AkhilSoodMD ( View Tweet)
Cannabis and Physical Function
Very small effects on meta-analysis
PO cannabis - 4% benefit (0.1-8%) of achieving at least MID of SF36 function scale
16S18 @BharatKumarMD
#ACR24 @RheumNow https://t.co/qQOYt1m3ub
Eric Dein ericdeinmd ( View Tweet)
Can multidisciplinary clinics improve quality of care for PsA?
Abstract 0596: Multidisciplinary care in PsA associated with ↓ time to first biologic, ↑ dermatology & nurse visits, and better CV risk assessment. #ACR24 @RheumNow https://t.co/2OnUR6te63
Akhil Sood MD AkhilSoodMD ( View Tweet)
Pasoto et al. Holding MMF for 1 week after zoster vaccine (RZV) improves response with no increase in flare @RheumNow #ACR24 Abstr#0247 https://t.co/q757bMFp7I https://t.co/rwjz3q3MaO
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Richard Conway RichardPAConway ( View Tweet)
Pharmacologics:
Cannabis absorption and metabolism is variable
Inhaled absorption 10-35%
THC is 97% protein bound, lipophilic and deposits in fat and spleen
Liver function is critical for THC metabolism
16S18 @BharatKumarMD
#ACR24 @RheumNow
Eric Dein ericdeinmd ( View Tweet)
Quinn @KQuinnRheum @petercgrayson et al. FDG-PET is not particularly useful in monitoring GCA on tocilizumab. Toc reduces but often not eliminate PET inflammation. PET activity does not predict relapse or vascular progression @RheumNow #ACR24 Abstr#0742 https://t.co/1qcJCGV118 https://t.co/6mBCgcbYo6
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Richard Conway RichardPAConway ( View Tweet)
Prevalence of HLH among pts w/SLE: lower than consults would suggest!
Observational study using NIS: 139 cases out of >100k pts w/SLE (0.13%); 6 fold increase in mortality
Fits my priors; HLH is overdiagnosed, but bad when it happens
@RheumNow #ACR24 Abstr#0619 https://t.co/iz3BlUOJb9
Mike Putman EBRheum ( View Tweet)
#Abstract0649
Acetylated albumin at K402 as a possible predictor for newly diagnosed lupus nephritis, distinguishing incident LN from SLE, treated LN & healthy controls.
@RheumNow #ACR24 https://t.co/aCRzt9TtoK
Akhil Sood MD AkhilSoodMD ( View Tweet)
Harkins @DrTrishHarkins et al. Serum disease activity markers in PMR. ROC analysis for active vs remission - fibrinogen (1.000), ESR (0.986), Haptoglobin (0.976), CRP (0.986), ALP (0.854). @RheumNow #ACR24 Abstr#0741 https://t.co/f8cX68Ov9Y https://t.co/zp5c7aQwxr
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Richard Conway RichardPAConway ( View Tweet)
#0066
🧬Epigenetics, Gut Microbiota & RA
🔬 110 RA patients v 110 controls
🦠 Collinsella abundance a/w DNA methylation changes (PRHOXNB, TBC1D22A) in RA, correlating with disease activity.
💡❔Role of gut microbiota & epigenetic markers as RA biomarkers
#ACR24 @RheumNow https://t.co/yZn0KkRpE6
Caoilfhionn Connolly CaoilfhionnMD ( View Tweet)
Is biologic response different in men vs women with axSpA?
A Meta-analysis of 11 studies including 11,199 axSpA pts evaluated sex-related response to bDMARDs
-Male pts more likely to achieve BASDAI 50 and ASDAS low disease activity responses compared to females.
#Abst0599… https://t.co/FopBLS4bF6 https://t.co/PpoZB9HwZN
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Adela Castro AdelaCastro222 ( View Tweet)
Dunn et al. Are the medications recommended for RA-ILD by the ACR guidelines used in the real-world. NO! 4108 RA-ILD patients. Only 12% on one of the first line recommended therapies! @RheumNow #ACR24 Abstr#0214 https://t.co/OzW90OA1Vd https://t.co/S1MKmEDrLF
Links:
Richard Conway RichardPAConway ( View Tweet)