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NORD-STAR Trial: outcomes in tx-naïve, early RA pts after 48w of csDMARDs+GC vs bDMARD (ABAtacept, CerToliZumab, or ToCiluZumab)+MTX
➡️ Superior CDAI remission rates w/ ABA+MTX & CZP+MTX but not TCZ+MTX vs csDMARD+GC
➡️Imaging progression low in all
Abst#0825 #ACR21 @RheumNow https://t.co/QaFIF4WNEG
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
#Abs0588 Effectiveness of TNFi vs non-TNFis in obese patients with #rheumatic disease @MilenaGianfran:
👉🏼>16000pts @ACRheum RISE
👉🏼Abatacept➡️larger decreases in CDAI in obese pts
👉🏼Tocilizumab➡️larger decreases in CDAI in non-obese pts
@RheumNow #ACR21
https://t.co/bL5xnG1iNh
Mrinalini Dey DrMiniDey ( View Tweet)
Does #comorbidity burden affect treatment of #InflammatoryArthritis?
Abs#0577 #ACR21
👉🏼~6500pts; 11 types of IA
👉🏼Higher comorbidity burden➡️more likely to receive steroids than TNFis
👉🏼Are patients w/ IA & multiple comorbidities receiving suboptimal therapy?
@RheumNow #ACRBest https://t.co/iIERb0wL4Y
Mrinalini Dey DrMiniDey ( View Tweet)
Predictors of clinical remission in AS patients Rx with TNFi
⭐️Age and 3-mo BASDAI improvement➡️ predictor of clinical remission criteria
⭐️Normalized ESR and CRP at month 3 were predictors of achievement of BASDAI-CRP
Abst#0931 #ACR21 @RheumNow https://t.co/Ot1ypgNg3A
swethaann23 swethaann23 ( View Tweet)
Baseline/ Clinical /Imaging predictors of flare when tapering TNFI in axSpA in remission:
⭐️🔼Baseline physician global VAS 🔼flare in 16 weeks after tapering to 2/3 of standard dose.
⭐️🔼Age 🔼flare within 16 weeks after tapering to 1/2 dose
Abst #0929 #ACR21 @RheumNow https://t.co/EFiwKA8z99
swethaann23 swethaann23 ( View Tweet)
Turkish study finds that ETN may be negatively associated w/ the development of ADA in AS pts. Abs 0936 #ACR21 #RheumNow @RheumNow https://t.co/z3pYDpp1NN https://t.co/MR1R41rCHV
Dr. Rachel Tate uptoTate ( View Tweet)
Evaluate effectiveness and Rx survival of different TNFI in cohort of axSpA
⭐️No difference among different TNFI
⭐️No difference between nr-axSpA and AS
⭐️Failure to initial TNFI did not diminish effectiveness or drug survival of subsequent TNFi Rx
Abst#0938 #ACR21 @RheumNow
swethaann23 swethaann23 ( 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)
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)
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)
ORAL-Surveillance, an open label Phase 3b/4 RCT of tofacitinib (JAKi) vs TNFi in RA
Numerical elevations in MACE and MI, highest among pts w/hx of CAD or high 10-year risk for MACE
I have been considering baseline CVD / VTE / CA risk when prescribing these since this broke https://t.co/8DAx8IgnZM
Mike Putman EBRheum ( View Tweet)
Factors associated with Anti Drug Ab against TNFi over 2-y in axSpA pts are:
⭐️ 🔼 Disease activity
⭐️Development of adverse events
⭐️Treatment discontinuation
Abst #0936 #ACR21 @RheumNow
swethaann23 swethaann23 ( 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)
MACE risk Tofa vs TNFi ORAL surveillance: age 50+ w/1 additional CV risk, MTX-IR
👉higher # MACE, MI in Tofa 5 or 10 mg bid (no increase in stroke)
👉risks for MACE w/tofa: tobacco, ASA, age 65+, male sex
👉counsel high risk pts (?avoid use)
Abst#0958 #Plenary #ACR21 @rheumnow https://t.co/tg35cts9tw
TheDaoIndex KDAO2011 ( View Tweet)
Oral Surveillance outcomes in a nutshell Tofacitinib two doses vs TNFi event driven trial more AEs of interest in Tofa groups MACE Malignancy SIE in older groups VTE esp #tofacitinib 10 mg BID @RheumNow #ACR21 #ACRBest abst#0958 https://t.co/j39g7yVVFB
Janet Pope Janetbirdope ( View Tweet)
Dr Naovarat reports on 18 year outcomes of HIV and rheumatic disease. 16 patients treated with TNFi, including 2 who switched to tocilizumab and ustekinumab. No major infections. Rising viral load in 1 led to discontinue. Abstr#0965 #ACR21 @RheumNow https://t.co/jcGPaURKmb
Richard Conway RichardPAConway ( View Tweet)
1133 MACE events in Oral Surveillance study - Tofa use in high risk pts had more MACE events than TNFi use. Abstr# 0958 #ACR21 Problems with the gimmish are:
- Older patients, w/ Hi CV Risk
- 50% prednisone use
- Use of TNFi as comparator (effective at lowering CV risk) https://t.co/lzIyhgzvRe
Dr. John Cush RheumNow ( View Tweet)
⭐️IR for MACE, MI, non-fatal MI numerically ⬆️ in Tofa vs. TNFi
⭐️HR for MACE/MI/stroke >1 for Tofa vs. TNFi
⭐️Risk factors: Smoking, ASA use, Age>65, men
⭐️Pts without risk factors, IR for MACE were similar
Abs#958
#ACR21 @RheumNow #ACRBest
https://t.co/xA3aGu5Sqi https://t.co/VnPHBhrmdx
Robert B Chao, MD doctorRBC ( View Tweet)
