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Perspectives on CV safety: JAK inhibitor (Tofacitinib) and TNF inhibitors

Janet Pope, MD, MPH, FRCPC

Safety comparisons of JAKi (tofacitinib) vs. TNFi from Oral Surveillance showed that, in patients with active RA on MTX and aged >50 years with one or more CV risk factors, that there was numerically more MACE events, malignancies, and VTE especially in higher dose.

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RheumNow Podcast - ACR 2021 Rehash (the good stuff..)

Jack Cush, MD

The ACR 2021 meeting has concluded. Dr. Jack Cush recounts a few more great abstracts from this past week’s virtual meeting.

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RA: Cardiovascular Risk Stratification and Potential Predictors of Risk

Meral K. El Ramahi, MD, FACP, FACR

Early cardiovascular disease assessment and management is critical at diagnosis in patients with Rheumatoid Arthritis (RA).

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Cognitive Impairment in Patients with Rheumatoid Arthritis

Akhil Sood, MD

Evidence suggests that RA patients are at increased risk for cognitive impairment. This is likely mediated by certain factors, including chronic inflammation and accelerated atherosclerosis. In the clinical setting, it is important to identify RA patients at increased risk for cognitive impairment.

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ACR21 – Day 3 Report

Jack Cush, MD

Hitting the home stretch, day 3 presentations were big! Here are a few of my favorites: secukinumab efficacy in juvenile PsA; VEXAS - predicting poor outcomes; and the FDA Safety Update session.

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Pulmonary Hypertension in Adult Onset Still's Disease: Dr. Jack Cush reviews poster #1100 presented at the #ACR21 annual meeting. https://t.co/2YGPHT3AAO https://t.co/lLRKnxB04a

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Dr. John Cush RheumNow ( View Tweet)
Long Term Steroid Use in RA - Matters of the Heart: Dr. Mrinalini Dey ( @DrMiniDey) discusses abstract #1428 presented at the #ACR21 annual meeting. https://t.co/E6RSlPAuRT https://t.co/QBhKD855aH

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Dr. John Cush RheumNow ( View Tweet)
ICYMI: Perspectives on CV safety: JAK inhibitor (Tofacitinib) and TNF inhibitors https://t.co/g5FirIK9Af https://t.co/63s7IaKhl7

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Dr. John Cush RheumNow ( View Tweet)
Who declines most with #scleroderma #ILD - early dcSSc, ⬆️CRP, ⬆️mRSS all w more ⤵️FVC. Results verified in SENSIS trial of SSc ILD where #nintedanib was superior to placebo abst#1846 #ACR21 @RheumNow https://t.co/eckUj0qwch
Janet Pope Janetbirdope ( View Tweet)
Hospitalisation for heart failure ⬆️ in inflammatory diseases. RA>PsA>AS>PsO . HRs 1.1-1.6 compared to general population. Abstr#1925 #ACR21 @RheumNow https://t.co/kKlGQM5Tcg
Richard Conway RichardPAConway ( View Tweet)
#ACR21 Ab#1939: Tofa CV Outcome (STAR-RA) ▶️Pooled data does not show ⬆️ risk of CVD ▶️Trend in pts w prior CVD -HR 1.27 (0.95-1.7), cannot r/o CVD risk in pts w risk factors Less clear than oral surveillance data, but concerns in those w risks https://t.co/JOKNyYVZfX @Rheumnow https://t.co/GGYJfxcqhc

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Eric Dein ericdeinmd ( View Tweet)
STAR-RA, CV risk large insurance datax3 tofa vs TNFi all comers: HR 1.01 (0.83-1.23) one CV RF + any MTX: HR 1.24 (0.90-1.69) prev CVD: HR 1.27 (0.95-1.70) not sig but surely okay to say baseline CV risk + tofa makes me a little nervous? @SeoyoungCKim #ACR21 ABST1939 @RheumNow https://t.co/LmmL5zgv9u
David Liew drdavidliew ( View Tweet)
Elevated CRP levels (>3) in PsA associated with ⬆️risk of cardiovascular events ⭐️NSAID use significantly REDUCED risk of CV events Abs#1920 #ACR21 @RheumNow https://t.co/gIz9f4SlWo https://t.co/V4uDeO3Iuz

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Robert B Chao, MD doctorRBC ( View Tweet)
Another study linking long term GC and CV risk in RA! Medicare data >65yo 130000+ pts 1-year incidence CV ⬆️ as follows: 📍Dose ≤5mg 1.4% 📍Dose 5-10mg 1.7% 📍Dose >10mg 1.9% Not replicated in younger pts (Optum data) #ACR21 #Abst1915 @RheumNow https://t.co/DLXdfvfiBW
Aurelie Najm AurelieRheumo ( View Tweet)
Can we predict who will develop #RA-ILD? Perhaps anti-MAA is the answer! #ACR21 Abs#1916 👉🏼⬆️anti-MAA antibody assoc with incident ILD risk 👉🏼Associations are antigen & isotype dependent 👉🏼Antibody measurement may be useful to risk stratify for RA-ILD @RheumNow https://t.co/nC0OkuWtGU
Mrinalini Dey DrMiniDey ( View Tweet)
#ACR21 Abs#1915 👉🏼Chronic steroid use in older adults on stable DMARD therapy assoc w/ ⬆️CV risk 👉🏼Risk even present among older adults receiving low dose ≤5mg/day 👉🏼Larger studies needed in younger healthier adults @RheumNow https://t.co/Lsj5YBz7IG
Mrinalini Dey DrMiniDey ( View Tweet)
OK is this a swan or a swan song? Graph looks like a swan 🦢 but message is NO #MACE differences in PsA on csDMARDs v #biologics #ACR21 abst#1833 @RheumNow https://t.co/TM91z5wiFY

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Janet Pope Janetbirdope ( View Tweet)

Composite MACE outcomes no different among PsA pts treated w/ biologics and DMARDs. Abs 1833 #ACR21 #RheumNow #ACRbest @RheumNow https://t.co/TxyE4Uqttq https://t.co/Eykxwmcc44

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Dr. Rachel Tate uptoTate ( View Tweet)
Post hoc analysis of pooled data from 19 clin trials on SEC & CV risk & systemic #inflammation in PsO, PsA, AS 📌Traditional CV parameters remained stable on all SEC treated grps 📌SEC sig. ⬇hsCRP & NLR @RheumNow #ACR21 abs1835 https://t.co/iCaGFbXNXn
sheila RHEUMarampa ( View Tweet)
Advantages of treat to target (of serum urate) beyond less gout flares? Maybe equal to ⬇️MACE events - I hope in long term less MACE due to less ⬆️CRP w flares. Modelling observational study abst#L06 #ACR21 #ACRBest @RheumNow below is comparative safety T2T better than usual care https://t.co/95M6lNX416
Janet Pope Janetbirdope ( View Tweet)
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