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Are TYK2 inhibitors ‘ticked’ to be part of the JAK family?
Are TYK2 inhibitors JAK inhibitors? Are they effective in PsA? Are they safer than JAKi? Read on to learn more.
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JAKi for nonradiographic axSpA
One area of continued interest for many rheumatologists is the field of non-radiographic axial spondyloarthritis. Furthermore, the question of the utility of JAK inhibitors for the treatment of axial spondyloarthritis has been on the rise.
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Updates in Psoriatic Arthritis at EULAR 2022
At EULAR 2022, I look forward to key topics and presentations in psoriatic arthritis (PsA). Here's a preview of nine studies I'm particularly interested in at this meeting.
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RNL 2022: Rheumatoid Arthritis - Best Management
This week's Tuesday Night Rheumatology, hosted by Dr. Jack Cush, featured highlights from the 2022 RheumNow Live Rheumatoid Arthritis - Best Management Pod, followed by a lively audience Q & A. Lectures featured:
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JAKi for nonradiographic axSpA
One area of continued interest for many rheumatologists is the field of non-radiographic axial spondyloarthritis. And the question of the utility of JAK inhibitors for the treatment of axSpA has been on the rise.
https://t.co/xq8ICyKKv0 https://t.co/o2iUgyU60A
Links:
Dr. John Cush RheumNow ( View Tweet)
#EULAR2022 ASAS/EULAR AxSpA Recs
⭐️Last: 2016
▶️All: education, exercise, 🚭
▶️❌csDMARD for axial disease
▶️TNF/IL17 (or JAK) with high disease: ASDAS>/=2.1
▶️Monoclonal TNF for uveitis/IBD, high PsO: IL-17
▶️Sustained remission: tapering of bDMARD "can be considered"
@RheumNow https://t.co/3yYU0Vb37r
Eric Dein ericdeinmd ( View Tweet)
RABBIT registry data on CV events with JAKi. Incidence rate low 0.41/100PY. No increase compared to TNFi RR 0.94 (0.39-2.38). No increase in high-risk group RR 0.90 (0.37-2.17). Reassuring with wide CI's. @RheumNow #EULAR2022 OP0135 https://t.co/vBSsnfeBoR https://t.co/iYDZsNwMye
Links:
Richard Conway RichardPAConway ( View Tweet)
#EULAR2022 OP0135:
German RABBIT 🐇 Registry:
⭐️ Observational, 46% Tofa, 54% Bari
No increased rate of CVD in JAK vs TNF inhibitor
🚨Unlike the ORAL Surveillance
@RheumNow https://t.co/O4IXg22Ybc
Eric Dein ericdeinmd ( View Tweet)
RABBIT registry and MACE in RA
No difference between
*JAKi (Tofa and Bari) and *TNFi in both unselected and high CV risks patients.
🧨 different than ORAL surveillance
but Observational and overall Low incidence (28 events).
#EULAR2022 @RheumNow OP0135 https://t.co/o8rngHrwQF
Aurelie Najm AurelieRheumo ( View Tweet)
Upadacitinib shows promising response in the treatment of nr-AxSpA in the SELECT-AXIS 2 study. Deodhar et al showed the ASAS40 response rate for UPA was twice vs placebo (45% vs 23%). 12/14 of the secondary endpoints were also met #EULAR2022 @RheumNow OP0016 https://t.co/dOWVJdLRtG
Dr. Antoni Chan synovialjoints ( View Tweet)
Have always been fascinated by the idea that some b/tsDMARDs might have effects on pain and fatigue beyond inflammation control.
Baricitinib data in RA before, & now this from guselkumab. Substantial effect on pain beyond SJC/CRP attributable?
POS1030 #EULAR2022 #IL23 @RheumNow https://t.co/fxqIGnlkwU
David Liew drdavidliew ( View Tweet)
SELECT-AXIS 2: RCT UPA 15 mgQD vs. PBO in NRAxSpA
as expected:
↘️disease activity
↘️pain and function
↘️QoL
at 14 wks
no new safety alerts https://t.co/2efpx7Mi6i
Aurelie Najm AurelieRheumo ( View Tweet)
Interesting, NWA by Dougados et al shows both Tofa and ADA may benefit pain in those who have controlled inflammatory component. ?real effect vs imperfect measures @RheumNow #EULAR2022 OP0052 https://t.co/aYBTaSDa3v https://t.co/dkLv1l5tFy
Links:
Richard Conway RichardPAConway ( View Tweet)
Phase 3 RCT upadacitinib in nrAxSpA. Clinical (ASAS40), PRO, and radiologic response seen at week 14 vs placebo @RheumNow #EULAR2022 OP0016 https://t.co/s3Vf4QiiAD https://t.co/gzlxZ3sxHF
Links:
Richard Conway RichardPAConway ( View Tweet)
#Bestinclass #EULAR2022 #PsA @RheumNow #OP0027 #CVE #MACE with #Tofacitinib in #psoriatic #arthritis and #PsO with median 3 to 4 yrs Rx. 40% metabolic syndrome which is high. There was no comparison. As expected hose with ⬆️MACE risks had more outcomes. https://t.co/sTjFHsUxzi
Janet Pope Janetbirdope ( View Tweet)
#EULAR2022 POS0241 shows JAKi ⬇️ pain catastrophization/central sensitization in RA patient via CSI (Central Sensitization Inventory) and (PCS) Pain Catastrophizing Scale.
No decrease of articular inflammation on ultrasound with JAKi shown, but study had just 22 pts
@RheumNow
Eric Dein ericdeinmd ( View Tweet)
@Rheumnow #EULAR2022 POS0240
▶️ In 2021, 73.6% of Belgian RA patients staring a JAKi, started a 2nd generation JAKi (UPA, FIL).
Predictors for 1st generation usage (BAR, TOFA): older age, prior DMARD therapies.
What would you start as a first JAKi?
Eric Dein ericdeinmd ( View Tweet)
#EULAR2022 RA updated reccs w/ minor changes: start MTX+GC, reduce GC rapidly, JAKi are recc only for pts w/o risk factors for CV or malignant dz (not sure I agree with this last one if the JAKi is the best drug for the pt and there are little options avail) @rheumnow https://t.co/CXyyCi6LVI
TheDaoIndex KDAO2011 ( View Tweet)
After the #EULAR2022 Recommendations session, it begs the question - Do we follow it?
In Germany, the answer is sometimes
Early bDMARD or JAKi is more frequent in recent years. 1/3 of patients did not receive recommended treatment escalation after 1st csDMARD
POS0234 @Rheumnow https://t.co/0DaP5b7Htc
Eric Dein ericdeinmd ( View Tweet)
Looking forward to reading/watching the coverage of #EULAR2022 by our outstanding faculty, including Drs., Rachel Tate @uptoTate, Kathryn Dao @KDAO2011,
Robert Chao @doctorRBC , Janet Pope @Janetbirdope and Antoni Chan @synovialjoints . https://t.co/oBQCxzdzfF
Dr. John Cush RheumNow ( View Tweet)
