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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)
#ACR21 Abst#0285
Calculated 10-yr CV risk ↑ w/in 1st yr of new RA dx in 53 Dutch pts:
➤43% had intermediate (I) or high (H) morbidity risk
➤76% had I or H mortality risk
◘ avg 57yo, 74%♀, 72% HTN, & 57% HLD
*️⃣ Early CV risk assessment critical at RA diagnosis!
@Rheumnow
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
#ACR21 Abst#0271
➡️Patients 40-75 yo w/ RA dx in the prior 5 yrs have ⬆️ prevalence of subclinical athero vs age-matched controls.
→ Should we consider obtaining a carotid US at time of RA dx & monitor per risk status to help optimize CV risk? @Rheumnow
https://t.co/3PpHIRk984 https://t.co/ChRTU7zACk
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
Prolonging the Controversy of Hydroxychloroquine
Dr. Kathryn Dao (@KDAO2011 ) shares several abstracts from #ACR21 that addressed the topic of HCQ and cardiovascular safety.
https://t.co/J6sVzYJkUZ https://t.co/dBZmtwQ927
Links:
Dr. John Cush RheumNow ( View Tweet)
