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The absolute eosinophil count (AEC) on a routine complete blood count could be a useful addition when deciding which patients to work up for RA-ILD.
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Obesity is associated with poorer physical function and treatment response in rheumatoid arthritis (RA). The ACR guideline on exercise, rehabilitation and diet supports discussing healthy body weight as part of wider RA care. But what happens to patients’ symptoms when they lose weight after starting GLP-1-based treatment?
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ACR Convergence was off to a big start with the year in review, posters and plenary sessions. Here are a few of my favorite presentations from todays Plenary I session at ACR Convergence.
Dr. John Cush
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David Liew
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PD-1 agonists & RA:
peresolimab ph2b failed safety/efficacy
rosnilimab ph2b better for both
how confident on efficacy?
translational shows it's deeper where it counts
do differences matter?
(membrane proximal, ligand sparing, ?dual action)
we will see
ABST0868 #ACR26 @RheumNow https://t.co/P3FjrUKhwE
Dr. John Cush
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TARA study from China - Ph2 H2H Girocitinib (JAK1/TYK2i) vs Tofacitinib in active RA refractory to bDMARDS. 459 pts, ACR50 @wk 24 Giro 73% vs Tofa 49% (p<0.0001), also superior at ACR20, ACR70, DAS remission, CDAI<10. H.Zoster 3%. Abst#LB21 #ACR26 https://t.co/JZLjQx4vSa https://t.co/51gaIOKTWf
Mrinalini Dey
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Ultra-processed food & RA: In 108,886 participants, highest vs lowest intake was associated with incident RA (HR 2.58), but the association lost significance after nutrient adjustment. Findings support a potential role of dietary quality in RA development @Rheumnow #0949 #ACR26
Mrinalini Dey
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In 64 RA patients randomized to ITIS or Mediterranean diets, both groups improved over 3 months, with distinct microbiome/metabolomic response patterns. Different dietary interventions achieve clinical benefit through complementary biological mechanisms. #0948 @Rheumnow #ACR26 https://t.co/Ls1awH3pgE
Henrique Dalmolin
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MTX hold 2 wk after each RZV dose: better T-cell response
RCT substudy, n=38, stable ARD
gE CD4 responders 65→95% hold vs 61→67% continue (p=0.038)
IL-2/TNF-α driven
Reasonable in stable pts. Wait for a bigger trial.
＠RheumNow #ACR26 Abstr#0899 https://t.co/4bobGIAuZX
Mrinalini Dey
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A glimpse of RA's long-term course at diagnosis: in 75 early-RA patients, baseline synovial macrophage/B-cell/plasmablast signatures were linked to persistent activity at 5 years. Higher BMI also assoc with poorer outcomes. Exploratory PEAC data. @Rheumnow #0918 #ACR26 https://t.co/lQzB2kmvMD
sheila
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X-sectional study from Brazil eval’d CAC prevalence across PREVENT categories
Pop’n: Women w/ SLE 40-60yo and NO known ASCVD
For SLE pts classified as Low risk in PREVENT, 21.9% were CAC+ suggesting subclinical ASCVD
@RheumNow #ACR26 Abs0922 https://t.co/kMu6paK8Tv
Akhil Sood MD, MS
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Does holding MTX improve immune response to RZV?
Abs 0899: Holding MTX for 2 weeks after each dose was associated with:
• Higher gE-specific cellular immunity (65% → 95%)
• Greater cellular immune response, driven by IL-2 and TNF
@RheumNow #ACR26
Eric Dein
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#ACR26 @RheumNow
Ab#0478
Baricitinib in 84 RA-ILD pts
Improved/stable dyspnea 83%, HRCT 68% at mean f/u 48 mos. DAS28-ESR from 4.3 to 2.8, median pred from 5 mg/d to 0 https://t.co/HTjUY7mHkV
Eric Dein
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#ACR26 @RheumNow
Ab#0475 - AutoAb in ILD
48 pts analyzed
Anti-Sa Ab in 15%, Anti-CarP 25%
ILD in 8% pts, erosive RA in 15%
Sa - higher prev of ILD (43 v 2%), higher erosion but not signif
CarP not assoc w ILD, erosive disease (though previous associations have been reported)
Mrinalini Dey
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SUNSTAR (n=224): first head-to-head trial of 2 non-TNFi bDMARDs. SC tocilizumab did not demonstrate superiority to abatacept on week-26 CDAI change. A secondary composite response favoured tocilizumab (51% vs 36%); more infections reported. #0468 #ACR26 @Rheumnow https://t.co/TbRvR2qUZf
Eric Dein
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#ACR26 @RheumNow
Ab#0495
Leflunomide Duration and Dose - NOT associated with incident/progressive ILD
Longitudinal study of 184 RA patients
LEF associated with 4% lower risk of radiologic worsening, each gram of cumulative dose with 6.4% lower risk https://t.co/VeREpEQ5wc
Eric Dein
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#ACR26 @RheumNow
Ab#0448 Addition of Nintedanib to Abatacept in RA-ILD
80 pts progressive ILD, 263 non-progressive. NNTE added to 6 prog, 13 non-prog
Non-prog- no signif results
In prog RA-ILD, ABA+NINTE showed stabilized FVC on f/u over 48 mo https://t.co/MPpzqT4ajr
Brian Jaros, MD
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New IL-17 inhibitor on the block?
Post-hoc analysis of Izokibep (small, selective IL-17A inhibitor) shows significant improvement over placebo in high-threshold outcomes including ACR70 response by week 16
#Abst0360 @RheumNow #ACR26 https://t.co/5tXgxBXK3C
Mrinalini Dey
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Obesity & biologic response in RA: good EULAR response at 6m was 49.4% with obesity vs 61.1% without. A 5-lipid signature tracked non-response in obesity group. A possible metabolic link between obesity and treatment response. Requires further validation. @Rheumnow #0099 #ACR26 https://t.co/8cz9jPY9hJ
Richard Conway
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Jessen et al. Infection and ILD progression leading causes of death in RA-ILD. ILD was directly or indirectly involved in 2/3 of deaths. ILD-related deaths predominate with impaired FVC, infectious and CV deaths in those with preserved lung function @RheumNow #ACR26 Abstr#0503 https://t.co/VGdO7SsrJx
