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Let's look at MI first.
Well, the numbers don't look great for tofa here.
fatal MI very small numbers
non-fatal MI - well that doesn't look good
(do we have combined both tofa doses vs TNFi?)
HR > 2 seems less than ideal - this would represent a substantial RF
#ACR21 @RheumNow https://t.co/5HSXFrMJCu
David Liew drdavidliew ( View Tweet)
ORAL Surveillance: MACE events higher in TOFA vs TNFi. Independent risk factors: smoking, aspirin use, age ≥ 65 yrs, and male sex; TOFA vs TNFi tx in these pts assoc'd w/ numerically higher MACE incidence. Plenary Abs 0958 #ACR21 #ACRbest @RheumNow https://t.co/44af1KujqP
Dr. Rachel Tate uptoTate ( View Tweet)
Do you order EKGs in everyone starting HCQ? Do you avoid HCQ in patients with heart failure? Will these abstracts impact your practice? Click on link to read more....#ACR21 @rheumnow #HCQ https://t.co/fvUZAvNWa8
TheDaoIndex KDAO2011 ( View Tweet)
Tofacitinib vs TNF inhibitors in #RA patients +50yrs with >1 CV risk factor; the data from ORAL Surveillance that we have all been waiting for! #ACR21
Risk of MACE related largely to baseline CV risk https://t.co/SpuKTtP8ql
The Lancet Rheumatology TheLancetRheum ( View Tweet)
This is the overall MACE data. Those overall HR certainly in the wrong direction, even if they don't cross 1. #ACR21 https://t.co/5RGT3QMdti
David Liew drdavidliew ( View Tweet)
ORAL surveillance TOFA vs. TNFi:
in patients with > 50yo > 1 CV risk MTX IR
-# ⬆️ in MACE and MI (not stroke)
-MACE risk factors on TOFA smoking, >65 male gender
-# ⬆️ MACE in its w/ any of these RF
What are you going to tell your patients? #Abtr0958 #ACR21 #ACRBest @RheumNow https://t.co/81kVTH63bb
Aurelie Najm AurelieRheumo ( View Tweet)
okay, so let's look at the #ACR21 plenary as we go
so a reminder - FDA-mandated phase 3b/4 safety endpoint study
specifically looking at patients >50yo with at least one other CV risk factor
today we're looking at MACE: that's CV death (excl PE), MI, stroke
ABST0958 @RheumNow https://t.co/9U8Sahb9Q7
David Liew drdavidliew ( View Tweet)
CV events go down when #hydroxychloroqine dose goes up in SLE BUT only in non smokers. Maybe due to smoking attention of HCQ levels &/or smoking as a bigger risk for CV over rides HCQ dose? ⬇️cardiac events by 28% in non-smokers abst0871 #ACR21 @RheumNow #RheumPix https://t.co/XxgK7iRXWi
Janet Pope Janetbirdope ( View Tweet)
Jorge Plutzky, cardiologist perspective on RA at #ACR21
⭐️CANTOS: Canakinumab for MACE shows ⬇️ inflammation, no change in LDL. Improvement in MACE events
▶️Plutzky: "Proof of concept study"
@Rheumnow https://t.co/Xi9ZHxMtmu
Eric Dein ericdeinmd ( View Tweet)
We need to control not only inflammation but also lipids levels in our patients w/ IA! Dr Plutzky brilliantly talking us through CV risk and RA showing data on how poor LDL control and coronary microvascular dysfunction lead to worse long term CV outcomes.
@RheumNow #ACR21 https://t.co/o6GWHDai5z
Aurelie Najm AurelieRheumo ( View Tweet)
#ACR21 Clinical Pearl: Beware of low cholesterol!
Systemic inflammation can lower cholesterol levels! High inflammation and low cholesterol may INCREASE, not decrease risk of CVD!
This is the "lipid paradox"
@Rheumnow https://t.co/dK7hD8zkVP
Eric Dein ericdeinmd ( View Tweet)
@rheum_cat presenting a really well designed study looking at association between TNFi use and incident hypertension in axSpA. No association found. Abstr#0910 #ACR21 @RheumNow https://t.co/w7o1oDreVL
Richard Conway RichardPAConway ( View Tweet)
@KronzerMD @jeffsparks on association of respiratory diseases with incident RA. Upper airway diseases (sinusitis, pharyngitis) seem to associate even more strongly than asthma/COPD. Abstr#564 #ACR21 @RheumNow https://t.co/HvoBOs3OOF
Richard Conway RichardPAConway ( View Tweet)
Dr Mahajan on lung disease in early RA. Common, airway disease in 60%, parenchymal disease in 30%. But minimal/no progression over 1 year which is reassuring. Abstr#574 #ACR21 @RheumNow https://t.co/s9r06MSStF
Richard Conway RichardPAConway ( View Tweet)
Jorge Plutzky giving a cardiologist perspective at #ACR21. "We've gone from lower is better, to lowest is best" on LDL lowering. PCSK9 inhibitors have changed the game.
@rheumnow https://t.co/oaBE99beSA
Eric Dein ericdeinmd ( View Tweet)
MUC5B and RA-ILD. Dr McDermott @jeffsparks show that MUC5B is associated with RA-ILD, older age at RA diagnosis, and ILD within 5 years of RA onset. Is this a different disease to other RA or modulation by the promotor variant? Abstr#0576 #ACR21 @RheumNow https://t.co/r2fQqxVY6N
Richard Conway RichardPAConway ( View Tweet)
And here is ORAL-Surveillance, small increase in MACE and malignancy with tofacitinib vs TNFi. 1 extra MACE per 319-567 patient years, 1 extra malignancy per 275 patient years. Abstr#0831 #ACR21 @RheumNow https://t.co/wMJnspTTBy
Richard Conway RichardPAConway ( View Tweet)
ORAL Surveillance
In mod-severe RA pts >50yo, with CV RF & no hx malignancy, patient-years of exposure required for one event (vs TNFi):
MACE
tofa 5mg bid: 567
tofa 10mg bid: 319
malignancy
tofa 5mg bid: 276
tofa 10mg bid: 275
#ACR21 ABST0831 @RheumNow https://t.co/9vyXPTMFzj
David Liew drdavidliew ( View Tweet)
How can we better identify patients with #RA-ILD using #EHRs?
Abs#0561: previously validated algorithms have clinical & research utility when applied to EHRs, esp when well-integrated with key info such as CT chest reports
#ACR21 @RheumNow
https://t.co/OU8BdwqHpc
Mrinalini Dey DrMiniDey ( View Tweet)
