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Upadacitinib effective in treatment of ankylosing spondylitis pts refractory to biologic tx - phase 3 trial
Primary endpoint (ASAS40) and secondary endpoints met
No malignancy, MACE, VTE, death
@RheumNow #EULAR2022 ABST#POS0306 https://t.co/UL4hUJ0rQV
Robert B Chao, MD doctorRBC ( View Tweet)
Does treating spondyloarthritis early matter?
Systematic review showed in nr-axSpA tx with biologics may lead to better outcomes compared to established axSpA
axSpA - no difference in response between early vs. established disease
@RheumNow #EULAR2022 ABST#POS0302
Robert B Chao, MD doctorRBC ( View Tweet)
What guides treatment decisions in AxSpA? Bolt et al showed patients assessed in clinical remission, 1/3 had BASDAI >3.5. Treatment unchanged as low disease activity, awaiting effects of current Rx, complaints not related to axSpA, patient preference #EULAR2022 @RheumNow POS0303
Dr. Antoni Chan synovialjoints ( View Tweet)
Treatment of active SpA improves depressive symptoms in SpA with HADS-D score reducing. This was greatest for TNFi followed by NSAIDs and csDMARDs. TNFi reduced the proportion of patients (48% to 29%) with depressive symptoms at follow up Webers et al #EULAR2022 @RheumNow POS0304
Dr. Antoni Chan synovialjoints ( View Tweet)
Wetterslev et al showed that almost all of 108 axSpA patients in clinical remission flared during tapering,47% flared at 2/3 to ½ dose and 53% at 1/3 to discontinuation. Higher baseline physician global score was an independent predictor of flare #EULAR2022 @RheumNow POS0298 https://t.co/RELuiB3Enl
Dr. Antoni Chan synovialjoints ( View Tweet)
New in AS. Upadacitinib 15mg od was significantly more effective than placebo over 14 weeks in AS bDMARD-IR (ASAS40 45% vs 18% and the onset of effect seen by week 4), no new safety risks identified in the SELECT-AXIS 2 study by Van de Heijde et al #EULAR2022 @RheumNow POS0306 https://t.co/LCQBf38GWe
Dr. Antoni Chan synovialjoints ( View Tweet)
SELECT-AXIS 1 trial of upadacitinib in active #AS with an inadequate resp to prior biologic - pivotal phase 2/3 RCT of 420 AS pts (Dz dur 7.7 yrs; 83% B27+) showed better ASAS40 at wk 14 w/ UPA vs PBO (45% vs 18%; P<0.0001) #EULAR2022 POS0306 https://t.co/6ZBEvjRjqc https://t.co/GL0vlB34mE
Links:
Dr. John Cush RheumNow ( View Tweet)
So what diet to follow with autoimmunity in mind?
So many, all with different instructions.
Let’s concentrate on where they agree:
yes to fruits & vegetables
no to emulsifiers & processed foods
#EULAR2022 @RheumNow https://t.co/I9abweQOyZ
David Liew drdavidliew ( View Tweet)
Characteristics assoc outcomes PsO/PsA/axSpA @pedrommcmachado @rheum_covid bDMARDS, NSAIDs assoc better outcomes. Usually culprits assoc worse outcomes (age, CVD etc), and also disease activity and steroids @RheumNow #EULAR2022 OP0249 https://t.co/siLdQVj2jb https://t.co/BmdwspDhsG
Links:
Richard Conway RichardPAConway ( View Tweet)
Nossent et al Hospitalisation with opportunistic infection twice as high in RA vs AxSpA/PsA. Has IMPROVED over biologic era. To me, suggests benefits of proper disease control on infection risk
@RheumNow
#EULAR2022 OP0274 https://t.co/cqUoRti4We https://t.co/Ozz7jH3z4N
Links:
Richard Conway RichardPAConway ( View Tweet)
Michielsens et al T2T tapering of TNFi in AxSpA and PsA. 72% tapered, 28% discontinued TNFi. Month 12 LDA 69% vs 73%.Month 12 dose 53% vs 91%. Flares 85% vs 78%. Needed more NSAID 54% vs 24% and steroid 30% vs 17%. @RheumNow #EULAR2022 OP0261 https://t.co/EDBPOgg4sX https://t.co/ckPqaTdm4B
Links:
Richard Conway RichardPAConway ( View Tweet)
Increased risk of aortic regurgitation and atrial fibrillation in radiographic axSpA pts when compared to general population. No significant risk for AV block (II-III). Unclear if treatment affects cardiac risk in these patients.
@RheumNow #EULAR2022 ABST#POST0146
Robert B Chao, MD doctorRBC ( View Tweet)
COVID-19 mostly mild for majority of SpA patients.
Steroid use associated with more severe COVID-19 outcomes (OR 3.15).
TNFi found to be protective! (OR 0.26)
@RheumNow #EULAR2022 ABST#OP0254
Robert B Chao, MD doctorRBC ( View Tweet)
Perrot et al. Factors assoc severe COVID in SpA. corticosteroid intake (3.15 [1.46-6.76]), age (OR=1.06 [1.04-1.08]) while anti-TNF (OR=0.26 [0.09-0.78]) was protective @RheumNow #EULAR2022 OP0254 https://t.co/bIiEW6efQ2
Links:
Richard Conway RichardPAConway ( View Tweet)
#OP0249 #EULAR2022 Dr Machado presented pooled data >5000 pts. Poor #COVID outcomes in Pso, PsA and AxSpa were associated with the usual suspects: Age, male, high disease activity and comorbidities. No specific bDMARDs was associated. Good news for our patients @RheumNow https://t.co/itzmwqKCrH
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
Ok to taper?
In PsA and AxSpA pts on TNFi, a T2T w/ tapering strategy was non-inferior to a T2T w/o tapering.
69% of tapered group remained in LDA, 73% no-taper group in LDA after 12 months.
Taper group did use more NSAIDs, cDMARDs, steroids
@RheumNow #EULAR2022 ABST#OP0261
Robert B Chao, MD doctorRBC ( View Tweet)
Pregnancy data in SpA from 122 pts
40% flared during pregnancy, more frequent 2nd trimester, pts w/ axial dz
7 pts required start of TNFi during 2nd or 3rd trimester
40% post-partum
@RheumNow #EULAR2022 ABST#POST0151 https://t.co/cdFRhRuCVH
Robert B Chao, MD doctorRBC ( View Tweet)
SpA pregnancies in #EULAR2022 POS1051 found that 40% of pts flared, particularly during their 2nd trimester in those with axial involvement OR post-partum. Seven flares led to TNFi initiation in 2nd or 3rd trimesters and were without correlation in post-partum flares. @RheumNow https://t.co/0ZWjYMwmzn
Dr. Rachel Tate uptoTate ( View Tweet)
The third SARS-CoV-2 vaccine in IMID (RA, SpA, PsA, UC, CD) patients on immunosuppression improves the serologic response follow the first two vaccine doses and allowed them to close the gap compared to the two-dose vaccinated controls #EULAR2022 @RheumNow OP0192 Jyssum et al
Dr. Antoni Chan synovialjoints ( View Tweet)
#EULAR2022 OP0274
Hospitalization for TB and other opportunistic infxn (OI) w inflamm joint disease:
⭐️9% with RA, 6% with PsA and AS in Western Australia
⭐️Decrease overall since 1985, but recent increase
⭐️Sharp rise of mycotic infections
⭐️No PJP, likely due to ppx
@Rheumnow
Eric Dein ericdeinmd ( View Tweet)
