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Answering questions on how COVID-19 affects rheumatic patients
As we inch closer to a possible vaccine for COVID-19, we are finally filling in the details on how the pandemic is affecting every aspect of our patient’s lives.
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And we're off! #ACR20 year in review
⭐️@philseo's #Vasculitis lecture⭐️
Take home lessons/ remaining questions from GiACTA ⬇️
#ACRambassador https://t.co/7C9QxbUeNH
Elizabeth Graef SituationRheum ( View Tweet)
📌More #Vasculitis pearls from #ACR20 Year in Review
#PEXIVAS in a nutshell ⬇️
#ACRambassador https://t.co/PnoP7QIiYs
Elizabeth Graef SituationRheum ( View Tweet)
There are a number of important mimics of IgG4-RD that should be considered
🔵ANCA-associated vasculitis
🔵Multicentric Castleman’s disease
🔵Rosai-Dorfman disease
🔵Inflammatory myofibroblastic tumour
🔵Cutaneous plasmacytosis
🔵Erdheim-Chester disease
🔵Malignancy
#ACR20
Chris Wincup chriswincup ( View Tweet)
TAK & GCA differ in vessel involvement when it comes to the 👁👁
> TAK- large vessel lesions
> GCA- small vessel vasculitis
@RheumNow #ACR20 https://t.co/sa4VEvCKOt
sheila RHEUMarampa ( View Tweet)
@RheumNow #ACR20 abs1923 prosp cohort study of angiographic lesions in Takayasu’ &GCA: although infrequent new angio lesions more likely in TAK. Improvement is possible in both conditions, more likely to occur in TAK. Change in the branch arteries more dynamic than in the aorta https://t.co/2KsZ6o3vtP
Olga Petryna DrPetryna ( View Tweet)
Mavrilimumab (anti-GM-CSF) in GCA, phase 2
GM-CSF upstream to both Th1 & Th17 pathways; potential for dx-modifying??
PNL induction then enrol+PNL taper
GCA flare (ESR/CRP+Sx/imaging): mavrilimumab RRR 62%
Enormous potential, worth exploring!
Cid et al #ACR20 ABSTL06 @RheumNow https://t.co/mq5sTVGbPs
David Liew drdavidliew ( View Tweet)
Can you give TCZ for GCA with minimal steroids?
Everyone hates steroids, right?
GUSTO trial: IVMP 500mg x3d +TCZ sc q1w
14/18 achieved clinical remission at 24w (but mean 11w)
13/18 relapse-free
1/18 permanent visual loss
Is that tradeoff worth it?
#ACR20 ABST0515 @RheumNow https://t.co/H9rgSxL6VP
David Liew drdavidliew ( View Tweet)
Following RITAZAREM, would you use rituximab maintenance for ANCA-associated vasculitis patients (cost aside)? @RheumNow
David Liew drdavidliew ( View Tweet)
RITZAREM
(RTX vs AZA maintenance post RTX induction relapsing AAV)
what happened post-study?
After #ACR19, hope RTX confers ongoing benefit
Answer: no. Same decline
Is 1g q4m dosing not justified?
Does that mean RTX needs to be continued, and in whom?
#ACR20 ABST2052 @RheumNow https://t.co/tldGqca8xC
David Liew drdavidliew ( View Tweet)
VEXAS! Hot topic of the year #ACR2020 ABS#1953 @RheumNow https://t.co/RIQKsoWbHe
Bella Mehta bella_mehta ( View Tweet)
RITAZAREM trial long-term follow-up
-RTX vs AZA after RTX-induced remission in ANCA #vasculitis
-RTX superior to AZA to prevent relapse
-Relapse common regardless of therapy; high-dose RTX not effective beyond treatment period
Abs#2052 #ACR20 @RheumNow
https://t.co/bW7IaMnVCG
Mrinalini Dey DrMiniDey ( View Tweet)
L06: Mavrilimumab in #GCA
⭐️Efficacy and safety of MAV maintaining sustained remission 26w new and relapsing/ref #GCA
Flare risk ➡️ 62% risk ⬇️ of flare w/ MAV
Sustained remission➡️ 33% ⬆️ in MAV
No diff in new or relapsing/ref pts,
No diff in AE
#ACR20 #ACRambassador
Sebastian E. Sattui MD, MS SattuiSEMD ( View Tweet)
SLR comparing the 4-dose ANCA #vasculitis (AAV) rituximab regimen (widely used in RCTs) to 2-dose #rheumatoidarthritis RTX regimen (common in clinical practice), to induce AAV remission, finds no difference in efficacy or safety.
Abs#2048 #ACR20 @RheumNow
https://t.co/WBaWN9d8vs
Mrinalini Dey DrMiniDey ( View Tweet)
The avacopan story, stronger again:
(recall: avacopan targets C5aR)
endogenous anti-C5aR1 in GPA inversely correlates with dx activity, relapse
questions, via chair @philseo:
What happens to anti-C5aR1 with Rx?
Does this influence therapeutic strategy?
#ACR20 ABST2050 @RheumNow https://t.co/g4JfjQal8R
David Liew drdavidliew ( View Tweet)
Dr Cid presents phase 2 trial of anti-GM-CSF agent mavrilimumab in combination with steroids in GCA. 70 patients. Sustained remission at week 26 in 83.2% of mavrilimumab vs 49.9% of placebo p=0.0038. @rheumnow @DrPujaMehta1 #ACR20 Abstr#L06 #ACRbest https://t.co/MTuH0sAuWt
Richard Conway RichardPAConway ( View Tweet)
Novel predictors of early mortality in a cohort of GCA pts from Portugal:
🚩Older age at dx
🚩Tongue claudication
🚩Prior tx w/ anticoag
BP treatment at dx - predictor of early survival. @RheumNow #ACR20 abs1935 https://t.co/TGJNnZ8vTQ
sheila RHEUMarampa ( View Tweet)
Dr Benard reports an SLR and meta-analysis of 27 studies comparing 2 rituximab regimes in AAV. 375mg x4 and 1000mg x2 equivalent. Remission in 91% vs 85%. Similar adverse event rates @rheumnow #ACR20 Abstr#2048 https://t.co/I0feVuZ8iy
Richard Conway RichardPAConway ( View Tweet)
Dr Sanchez-Bilbao reports a study of 30 patients with LV GCA. Despite clinical remission with tocilizumab ongoing vascular inflammatory activity identified by PET in 70%. Significant implications for risk of tocilizumab withdrawal. @rheumnow #ACR20 Abstr#1921 https://t.co/f1isidSypn
Richard Conway RichardPAConway ( View Tweet)
Tocilizumab in GCA: what happens in the vessels?
Supporting excellent work @KQuinnRheum @petercgrayson earlier at #ACR20, LV-GCA data from Blanco/Gonzalez-Gay et al. Aorta still hot at 10.8±3.7 mo.
in LV-GCA on TCZ, clinical remission ≠ PET remission
#ACR20 ABST1921 @RheumNow https://t.co/ngBVL4rop8
David Liew drdavidliew ( View Tweet)
