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After failing a JAK inhibitor, can you still hit a JAK-pot?
Januse kinase (JAK) inhibitors are targeted synthetic disease modifying anti-rheumatic drugs (tsDMARDs) that have risen in popularity as earlier treatment options for rheumatoid arthritis.
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JAK Inhibitors in Refractory Adult and Childhood-Onset Still’s Disease
Still's disease is an autoinflammatory disease characterized by spiking fever, rash, polyarthralgia, sore throat and even life-threatening complications, such as macrophage activation syndrome. It was first described by George Still in the late 1800s.
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#ACR21 Abs#1442: JAKpot - Cycle JAK or switch to bDMARD after JAK failure?
▶️No difference between cycle vs bDMARD group
▶️Non-signif trends: cycled JAK better for inefficacy to 1st JAK, bDMARD better for adverse effects
@Rheumnow https://t.co/6UNUVh5ZW8 https://t.co/upfI6tDH1p
Links:
Eric Dein ericdeinmd ( View Tweet)
First JAKi failure: What's next? Wanna find out? It's here
https://t.co/o5CE1MBzUu
Abstr#1442 #ACR21 @RheumNow https://t.co/f0sdPn5mcZ
Aurelie Najm AurelieRheumo ( View Tweet)
⭐️ Wanna catch up with the latest news on JAKi safety trials presented at #ACR21? Our @Rheumnow interview with @ErnestChoy1 is out. Link below
https://t.co/zYb4rXcw1x https://t.co/i39xXnfC3Q
Aurelie Najm AurelieRheumo ( View Tweet)
Post-hoc analysis of Deucravacitinib (TYK2i) for tx of PsA showed similar efficacy in pts with and without background csDMARD use.
⭐️>60% w/ background csDMARD use, majority of which was MTX
⭐️no difference in AE
#ACR21
Abs#1352
@RheumNow
https://t.co/nIJT7rNkJP https://t.co/bq0x1Ywguo
Robert B Chao, MD doctorRBC ( View Tweet)
Does #baricitinib affect #fatigue in RA patients?
👉🏼Results from RA-BEAM and RA-BEACON
👉🏼4mg baricitinib significantly reduced fatigue, starting week 16, compared to placebo
👉🏼Effect independent of disease activity in active RA
Abs#1235 #ACR21 @RheumNow
https://t.co/0SKhUKJHd7 https://t.co/R76wc56u6I
Mrinalini Dey DrMiniDey ( View Tweet)
FDA Update session: Proven Benefit of Baricitinib in Hospitalized COVID-19 from the ACT2 and COV-BARRIER Studies, showing it does not need to be given with Remdesivir (4 mg qd maz 14days) #ACR21 https://t.co/r6crPtu3ZH
Dr. John Cush RheumNow ( View Tweet)
#RA pts on #baricitinib less likely to discontinue treatment & more likely to achieve remission than pts receiving biologic /other tsDMARD.
👉🏼Results from RA-BE-REAL observational study
👉🏼Bari(2 or 4mg) vs biologic/other tsDMARD
Abs#1223 #ACR21 @RheumNow
https://t.co/WRN1OCX9Bq https://t.co/UCFF6hAY7G
Mrinalini Dey DrMiniDey ( View Tweet)
Effect of BMI on PRO treatment response in PsA. Increasing BMI associated with lower response. More pronounced in TNFi than IL-17 or JAKi. Abstr#1327 #ACR21 @RheumNow https://t.co/qhgVlW72uM
Richard Conway RichardPAConway ( View Tweet)
Wk 12 disease activity predicts wk 24/26 remission/low disease activity with #upadacitinib 15mg in MTX-naïve or inadequate responders to MTX and/or TNFi pts.
≥50% improvement in SJC/TJC at Wk 12 was assoc with wk 24/26 remission/low disease activity.
Abs#1237 #ACR21 @RheumNow https://t.co/PAaCe5MAcu
Mrinalini Dey DrMiniDey ( View Tweet)
Baricitinib for *relapsing* GCA (Th1+Th17)
w abbreviated steroid wean (15-22w)
Despite being tougher to treat:
100% off steroids at 24w
93% off steroids at 52w
no ischemic Sx
promising as another GCA Rx option!
(post-cessation 4pts flared)
@MayoClinic #ACR21 ABST1396 @RheumNow https://t.co/dqFnHQYogk
David Liew drdavidliew ( View Tweet)
This feels like an excellent starting point for Tuesday's ORAL Surveillance malignancy discussion.
RWE Cohort: HR 1.01 (0.83-1.22)
RCT-dup Cohort: HR 1.19 (0.86-1.64)
ORAL Surveillance: HR 1.48 (1.04-2.09)
Interesting day 4 ahead!
great talk @SeoyoungCKim #ACR21 7S413 @RheumNow https://t.co/YSau21goMr
David Liew drdavidliew ( View Tweet)
Abstr 0983 mRNA SARS-CoV-2 Vaccine in RA Patients
Rubbert-Roth and colleagues found:
- RA patients developed anti-S1 antibodies slower and lower compared to controls
- Reduced titers among Abatacept & JAKi users
#ACR21 @RheumNow https://t.co/sXW8d53O8m
Akhil Sood MD AkhilSoodMD ( View Tweet)
TOFA Post hoc analysis on 2000pts:
⬆️ Paraoxonase PON1 activity associated w/
⬇ risk of malignancies (not NMSC) in RA pts treated w/ TOFA, Adj on RA duration, age, and smoking.
A promising biomarker! #Abst980 @RheumNow #ACR21 https://t.co/fOILnAyDN9
Aurelie Najm AurelieRheumo ( View Tweet)
#ACR21 Abst#0588. TNF vs non-TNFi in obese RA pts
⭐️TNFi use ⬆️ disease activity vs ABA in obese pts
⭐️TNFi use ⬆️ activity vs TCZ in non-obese pts
⭐️No diff w RTX, Tofa
▶️Further research needed: Wt-based dosing? SC vs IV?
https://t.co/K8WycPTgxW @Rheumnow #ACRBest
Links:
Eric Dein ericdeinmd ( View Tweet)
ORAL Surveillance MACE conclusions:
So this is fair: tofacitinib acts as a CV risk factor, there are many others, we need to address CV risk in RA pts.
Nevertheless, in terms of MI risk, tofa vs TNFi, if I had one CV risk factor, I know what I'd do.
#ACR21 ABST0958 @RheumNow https://t.co/4Z79XtTzl9
David Liew drdavidliew ( View Tweet)
SELECT-AXIS 1: UPA 15 mg QD consistently efficacious over 2 years for ASAS40. Low radiographic progression rates in AS pts. No new safety findings were observed. Abs 0924 #ACR21 #RheumNow @RheumNow https://t.co/CWvH1OPGyR https://t.co/uC67fJZDCE
Dr. Rachel Tate uptoTate ( View Tweet)
Abst0509 #ACR21 @RheumNow study of plasma concentrations of Deucravacitinib show high functional selectivity for TYK2 while Tofa, Upa & Bari inhibit JAK1/2/3 to varying degrees show no meaningful inhibition of TYK2. Distinct class of kinase inhibitor as compared to JAKs
Olga Petryna DrPetryna ( View Tweet)
With Deucravacitinib, a TYK2 inhibitor vs placebo, PsAID-12 and PsAID-9 scores were significantly improved
versus baseline at Week 16
and other PROs showing a clear improvement in PsA-related impact @RheumNow #ACR21 Abst#0750 https://t.co/JbeSE2dO94 https://t.co/pH79dXCYSs
Dr. Antoni Chan synovialjoints ( View Tweet)
