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Practical use of JAK inhibitors in select groups in Axial SpA
A new treatment for AxSpA that has come on the scene are JAK inhibitors. In clinic, considerations for JAKi use are body mass index, smoking status, prior use of biologics and patients with high inflammatory states such as high CRP and inflammatory change on MRI scan of the spine and sacroiliac joints. There are further studies at #ACR22 which help answer these questions.
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NSAIDs plus TNFi (celecoxib and golimumab) therapy in ankylosing spondylitis did not show significant decrease in radiographic progression compared to TNFi monotherapy.
*Numerical reduction in syndesmophytes 11% vs. 25%
Abs#0546
@RheumNow #ACR22
#ACRBest https://t.co/pG5F3xdsh9
Robert B Chao, MD doctorRBC ( View Tweet)
Abs 0419 SELECT-AXIS 2, UPA improved outcomes vs PBO in nr-axSpA pts across all BL inflammation subgroups; greatest benefit obs in pts with both elevated CRP and inflammation on baseline MRI. #ACR22 @RheumNow https://t.co/opaFwXgcvU https://t.co/o27ULcL8Ip
Dr. Rachel Tate uptoTate ( View Tweet)
#Abstr 0545 GO-BACK Trial
Continue vs Withdrawal of GOL in nr-axSpA with inactive disease
- Full tx withdrawal associated w/ dx flare
- Re-treatment -->rapid clinical response after flare
- qMonthly tx --> higher rates of disease activity improvement
@RheumNow #ACR22 https://t.co/Z3bhA9D4RQ
Akhil Sood MD AkhilSoodMD ( View Tweet)
#ACR22 Abs 0408 @philipcrobinson et al, nr-axSpA pts achieving long-term clinical outcomes w/ CZP tx after 1 yr were generally sustained over 3 yrs across MRI+/CRP+, MRI−/CRP+ and MRI+/CRP− subgroups; ASDAS-MI numerically highest in MRI+/CRP+. @RheumNow https://t.co/cjpp2qCN4O https://t.co/G2YjF6ubUf
Dr. Rachel Tate uptoTate ( View Tweet)
Potential disconnect: Objective Inflammatory Response, OIR (MRI/CRP levels) vs Clinical Response,CR (BASDAI/ASDAS). Post hoc analysis AxSpA on Certolizumab. Majority of patients >50% improved OIR, only minority improved CR. Rudwaleit etal https://t.co/WdkmkCWClO #ACR22 @RheumNow https://t.co/qlNUFhnuJQ
Dr. Antoni Chan synovialjoints ( View Tweet)
2022 ASAS-EULAR Recommendations of AxSpA management
1) NSAIDs still first line
2) Analgesics/opioids contraindicated
3) TNFi, IL-17i first line bDMARDs, followed by JAKinibs
4) Tapering but not discontinuation of bDMARDs in sustained remission
Abs#0542 @RheumNow #ACR22 https://t.co/ffaN2fMc3v
Robert B Chao, MD doctorRBC ( View Tweet)
#Abstr 0542 ASAS EULAR Recommendations for Management of axSpA
'Absence of response to treatment should prompt re-evaluation of the diagnosis and consideration of the presence of comorbidities.'
@RheumNow #ACR22
Akhil Sood MD AkhilSoodMD ( View Tweet)
Liew @rheum_cat et al. No evidence of cardioprotective effect of early initiation of TNFi in AxSpA. In fact seemed to be associated higher risk! CVD (HR 1.17), stroke (HR 1.24), and MACE (HR 1.22) @rheumnow #ACR22 Abstr#0415 https://t.co/a9lpxQuMB9 https://t.co/GdGfYxcAH6
Richard Conway RichardPAConway ( View Tweet)
Maguire et al @Sineadm15 @bososhea Stronger relationship between disease activity and QoL in men than women with AxSpA. Our current tools may be inadequate to fully evaluate women with AxSpA @rheumnow #ACR22 Abstr#0406 https://t.co/duHqO0DXh3 https://t.co/yRcFiNpujT
Richard Conway RichardPAConway ( View Tweet)
Tofactinib efficacy for treatment of ankylosing spondylitis comparable across different BMI's. Regardless of BMI, tofacitinib better than placebo.
BMI <25: more AE and SAE
Abs#0405 @RheumNow #ACR22 https://t.co/qs3U4mjUXD
Robert B Chao, MD doctorRBC ( View Tweet)
Rates of MACE and VTE with upadacitinib were infrequent and consistent with background rates in RA, PsA and AS patients. Factors associated with MACE/VTE: age>65, HTN, DM, smoking, history CV event/VTE
Abs#0510 @RheumNow #ACR22 https://t.co/AjtJF0p3QK
Robert B Chao, MD doctorRBC ( View Tweet)
Therapies for AS and nr-AxSpA are coming together. Both AS and nr-AxSpA present with similar burden of disease. TNFi, IL-17i and JAKi now approved for use in nr-AxSpA.
Jose U Scher, SpA Review @RheumNow #ACR22 https://t.co/vcHcd7OyAU
Dr. Antoni Chan synovialjoints ( View Tweet)
Morning stiffness has the highest correlate to disease activity in pregnant AS patients, as demonstrated in Abs 0374. I will indeed be focusing on this much more for my patients. #ACR22 #ACRbest @RheumNow https://t.co/9bmlQtGsLH https://t.co/qrxebQ6Ow1
Dr. Rachel Tate uptoTate ( View Tweet)
@DiegoBenavent et al: Gender impacts disease outcomes in PsA and SpA. Women > BASDAI, >BASFI, > ASDAS, >ASDAS Hi, and > EQ-5D.
Not so surprising considering higher ratio for Fibromyalgia in W
ASDAS not asso w/ gender in AxSPA.
https://t.co/kBxvAi5qZw
Abstr #0381 #ACR22 @Rheumnow https://t.co/vxdtlKpT3l
Aurelie Najm AurelieRheumo ( View Tweet)
Xeljanz use in AS #ACR22 (@pfizer sponsored) @RheumNow
-Included patients with at least bilateral grade 2 SI or grade 3/4 unilateral SI
-5mg BID Xeljanz
-Significantly more patients had ASAS20/40 response, CRP reduction, & QOL, vs. placebo
-Onset of action noticed at 2 weeks https://t.co/DisKpgR0pt
Catherine Sims, MD DrCassySims ( View Tweet)
⬆️ correlation between BASDAI + ASQoL in 🙋♂️ vs 🙋♀️
What does this mean?
❓low disease activity in 🙋♀️ resulting in more marked ⬇️ in QoL❓
OR
❓Is there a need for gender stratified tools of disease activity❓
Abst#0406
#ACR22 @RheumNow @Sineadm15
Patricia Harkins DrTrishHarkins ( View Tweet)
Abstr 0373 created a scoring system to predict outcomes in SpA pts w/ uveitis
- Poor outcomes seen among smoking hx, females, +HLAB27, axial & peripheral involvement, high disease activity, inflammation, and b/l eye involvement
https://t.co/mGAn0Eel1O
@RheumNow #ACR22 https://t.co/qtJsavtG9z
Akhil Sood MD AkhilSoodMD ( View Tweet)
ACR year in review: a summary of latest FDA approvals in spondyloarthritis by C. Langford
#ACRyearinreview #ACR22 @RheumNow https://t.co/u5TyRdQM7L
Aurelie Najm AurelieRheumo ( View Tweet)
The new IL-17A/F inhibitor, bimekizumab, was comparable to current established therapies in active #AnkylosingSpondylitis. Check our NMA poster today. #ACR22 #SpA #medtwitter @TheBold_MD @cplch19 @UTSWRheum @ACRheum @RheumNow @DrCassySims https://t.co/vxa05r0GvS
Adela Castro AdelaCastro222 ( View Tweet)
