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Playing it Safe with RA? JAK vs. TNF Debate
Reported safety signals, at odds with the efficacy of these medications, have left rheumatology clinicians in a difficult position when considering when during a patient’s treatment course and in which patients, specifically, JAKi should be used. Two abstracts from ACR convergence 2024 further contribute to our understanding of this potential risk profile.
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Does CVD mortality risk change after stopping GC in RA?
➡️28078 incident GC users
➡️Incr mortality risk from CVD &infections persists post-cessation
➡️Risk never returns to pre-GC level after prolonged use
⏩Use GC at lowest dose for shortest time possible
Ab2673 #ACR24 @Rheumnow https://t.co/dtLU8obLke
Links:
Mrinalini Dey DrMiniDey ( View Tweet)
Ab2674 #ACR24
➡️Most pts starting 1st-line TNFi, who didn't achieve treatment response at 3M, also didn't achieve response from months 3-12
➡️1/4 pts achieving LDA/remission at 3M were no longer in LDA/remission at 12M
@RheumNow https://t.co/pFOo86tJTx
Mrinalini Dey DrMiniDey ( View Tweet)
An early favorable response to TNFi initiation indicates better long-term success in RA. Assess early and adjust treatment accordingly.
#ACR24 @RheumNow ABST#2674 https://t.co/YTThYiiLpZ
Jiha Lee JihaRheum ( View Tweet)
#ACR24 BEST Abstracts from Day 1
The RheumNow faculty have parked at the plenaries, trafficked the posters and have been finding the best the meeting offers on the first day.
https://t.co/FHu616Jpyq https://t.co/oKuRcGRRAZ
Dr. John Cush RheumNow ( View Tweet)
Wt ⬇️ = Better #PROs in
👇autoimmune #rheumatic #diseases if > 5% wt loss.
#ACR24 @ACRheum @RheumNow
Didn’t work for non overwt
Ex Normal BMI and T2DM 🤷 https://t.co/81OuTfZ0Nx
Janet Pope Janetbirdope ( View Tweet)
In this study by Dr CArriens et al, there was no difference between the vaccine response to Influenza by either HAI or Ab levels in Anifrolumab-treated pts.
AEs - mild, moderate
No serious aEs
💉#vaccinate your pts on anifrolumab with influenza
@RheumNow #ACR24 abs2424 https://t.co/XPwlzUS02i
Links:
sheila RHEUMarampa ( View Tweet)
Mortality Risk After Stopping Glucocorticosteroids (GC) in RA.
In a study of 28,078 RA patients:
Mortality risk from CVD ↑ 7.5%/year of GC use; ↓ 1.3%/year after stopping.
Mortality risk from infections ↑ 6.8%/year of GC use; ↓ 4.9%/year after stopping.
Risks normalize 1.5–10… https://t.co/i6cKet1EEV https://t.co/ClMjIly20E
Links:
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
#Poorer responses to #Rx in
#Females vs #males
Sex hormone and pathway differences
explained
👇
Biological differences
F start worse in disease activity
F May have ⬇️ response to #Rx
Yr in Preview C Ritchlin
@lihi_eder’s PsA work quoted
ACR24 @RheumNow @ACRheum @ACRBest https://t.co/EWoCvzOLiL
Janet Pope Janetbirdope ( View Tweet)
VACIMRA Study showed timing matters for Methotrexate and Pneumococcal Vaccine in RA.
RA patients vaccinated with PCV13 1 month before MTX initiation had higher responder rates at 1 month:
88% (ELISA) vs. 75%
96% (OPA) vs. 88%
At 12 months, responses remained stronger in… https://t.co/bSbIazsRtG
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Weinblatt et al. AMPLIFIED trial. No difference in response rates of RA to adalimumab or abatacept based on dual seropositivity/shared epitope status. Fits with my priors and refutes a previous pilot study. @RheumNow #ACR24 Abstr#2671 https://t.co/OUwnlsP6jU https://t.co/RBN6ivSKDr
Links:
Richard Conway RichardPAConway ( View Tweet)
Dumoulin et al. 4 year results of TREAT EARLIER trial of 1 year MTX in CSA. In high risk ACPA- group, reduced risk of RA development, 8.6% vs 29%, HR 0.27. No difference at 4 years in ACPA+ or low risk ACPA- @RheumNow #ACR24 Abstr#2672 #ACRbest https://t.co/S2yJm196UV https://t.co/bJ9JySteUs
Links:
Richard Conway RichardPAConway ( View Tweet)
In the AMPLIFIED study (phase 3, single-blind RCT) ABA not superior to ADA in patients with dual seropositive early RA and HLA Class II
#ACR24 @RheumNow ABST#2671 https://t.co/VSorAiJUIe
Jiha Lee JihaRheum ( View Tweet)
Is Pregnancy Truly the Solution for RA?
Pregnancy is perhaps the oldest treatment in rheumatoid arthritis (RA) and has been associated with a natural improvement in disease control in 50-75% of patients. Others, however, are not as successful with unchanged disease activity or… https://t.co/MesVIUl0fC https://t.co/760i5znmeu
Dr. John Cush RheumNow ( View Tweet)
Conversation with @RheumKay on his #ACR24 biosimilar talk for @RheumNow
https://t.co/LzAIGIG4wu https://t.co/CqSYLpJYAh
Eric Dein ericdeinmd ( View Tweet)
@drceowen @TheLancetRheum @RheumNow Efficacy in newly diagnosed & established PMR is not necessarily interchangeable
different treatment paradigm
?different immunologically
Many other diseases have different Rx for induction vs maintenance, early dx vs established.
Having said that: doesn't look great for MTX. https://t.co/89lByaYdYq
David Liew drdavidliew ( View Tweet)
If your pt with #rheumatoid #arthritis is
#exhausted - there is a reason
#Meta-analysis of 70000 RA Pts
#Insomnia is ⬆️4X vs gen population
Due to
▶️#pain
▶️#inflammation
▶️#depression
🤷♀️
#ACR24 @RheumNow @ACRheum abst#0480
Janet Pope Janetbirdope ( View Tweet)
Paraoxonase-1: Possible Biomarker for Progression to RA
Dr. Jonathan Kay discusses abstract 0464, Increases in Paraoxonase-1 Activity over Time Associates with Reduced Risk of Incident Inflammatory Arthritis in an Anti-Citrullinated Protein Antibody-Positive Population,… https://t.co/yhcCrrvjxH https://t.co/caf5dUvrOQ
Dr. John Cush RheumNow ( View Tweet)
JAK-pot! How fast do DMARDs work?
Dr. Mike Putman interviews Dr. Kim Lauper about abstract 0501, How Fast Do JAK-inhibitors, TNF-inhibitors, Abatacept and IL-6 Inhibitors Act in Rheumatoid Arthritis? An International Collaboration of Registers of Rheumatoid Arthritis Patients… https://t.co/GO9EwyrVpV https://t.co/lELE5SJW5i
Dr. John Cush RheumNow ( View Tweet)
RheumNow Day 3 Recap: ACR Convergence 2024 Highlights https://t.co/jFIATPKlp7
Links:
Dr. John Cush RheumNow ( View Tweet)
