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#ACRbest Abstracts – Day 2
Our reporters have been prolific in finding the hot abstracts, those that were most attended or those that are getting the most buzz on social media. Here are RheumNow's #ACRbest abstract reports from Monday, November 13, 2023 at #ACR23, covering The Great Debate, SGLPT2 inhibitors in SLE, the SMART Study of MTX, TMP/SMX Prophylaxis, RA-ILD & TNF Inhibitors, cancer research and more.
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#ACR BEST Abstracts from San Diego – Day 1
The RheumNow faculty reporters have been scouring the meeting for what they believe to be the best presentations from the first day at ACR 2023 in San Diego. From hundreds of online presentations, the poster floor and the plenary podium, here are some of the best abstracts from Sunday Nov. 12th. You can spot these on Twitter by looking for the (#ACRbest) hashtag.
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#irAE Baseline immune suppression does NOT protect against worsening synovitis flares when using check point inhibitors in Pts with established #inflammatory #arthritis #ACRbest #ACR23 @ACRheum @RheumNow abst1075 Data from #CanRIO database https://t.co/lOCf8Tbgta
Janet Pope ( View Tweet)
1-PJP prophylaxis or not in ANCA?
2-MTX single dose or split dose?
3-IL6 blocker early on in GCA/PMR?
4-SGLT2 in DM/Lupus nephritis?
5-Cervical cancer screening in Lupus?
6-TNF induced ILD?
https://t.co/mzGXajmQqE
@RheumNow , Daily recap
#ACR23
Nouf Al hemmadi ( View Tweet)
Still uncomfortable with IL-6i in GCA or PMR especially given the pt population and potential AE?
Be on the look out for NEW biologics!
Mavrilimumab
Secukinumab
and MORE!
@RheumNow #ACR23 https://t.co/gdcDIcvffa
Robert B Chao, MD ( View Tweet)
More nuanced poll for #GreatDebate #ACR23
@RheumNow
How should we use biologics for PMR/GCA?
Eric Dein ( View Tweet)
#ACR23 Great debate: should we use biologics at PMR/GCA onset?
Dr Spiera (Cons)
-Need to agree on clin important diff & flares
-No evidence as disease modifying in GCA
- No need for disease modifying in PMR
-Most pts can be treated with steroid & rapid taper
-Cost @RheumNow https://t.co/ptM8E7EQzF
Md Yuzaiful Md Yusof ( View Tweet)
Frailty in PMR @DrTrishHarkins >1/3 are frail or pre-frail. Frailty correlates with PROs - worse mood, pain, fatigue, and QoL. Abstr#1201 #ACR23 @RheumNow https://t.co/pH5yG4AscU https://t.co/QuHmOgpLbi
Richard Conway ( View Tweet)
The Great Debate #ACR23 - and it’s a cracker.
Is early steroid-sparing therapy justified in GCA/PMR? I don’t know, but Rob Spiera and @philseo will battle it out to tell us.
(and ably moderated by the always eloquent @SattuiSEMD)
I’ll put some highlights here ⬇️🧵
@RheumNow https://t.co/ASpuglyENv
David Liew drdavidliew ( View Tweet)
Baseline vascular ultrasound predicts clinical outcomes @ 3 months. Subclinical GCA = relapse 37% vs 15%. Higher cumulative steroid dose. @sharoncowley01 @DrTrishHarkins Abstr#1565 #ACR23 @RheumNow https://t.co/b35CkFS0lz https://t.co/suBGR1ByDK
Richard Conway ( View Tweet)
So firstly the no case, and Rob Spiera takes up the case, dictated by the electronic coin toss.
No-one disagrees that we need steroid-sparing options, or that IL-6Ri work in PMR and GCA. But it’s the strategy questions which remain in play:
#ACR23 @RheumNow https://t.co/I2QDU7l6DE
David Liew drdavidliew ( View Tweet)
@RheumNow #ACR23 #GreatDebate
Use Advanced Rx for GCA 1st line?
Spiera: No
No ev for disease modification with early Rx
Lose only reliable biomark of dis activity w IL-6 inhib
No evid of reduced major GC AEs
$$
GCA: treat by GC alone, taper off by 6 m, low threshold to escal https://t.co/QxgAlVKitd
Eric Dein ( View Tweet)
@RheumNow So what might early steroid-sparing therapy in PMR/GCA achieve?
Cure? Superior disease activity control? Minimize damage? Improve QoL/function?
Well, sadly we have a long way to go in defining a lot of this:
#ACR23 @RheumNow https://t.co/QeidAHHm8x
David Liew drdavidliew ( View Tweet)
@RheumNow So in GCA, we don’t know if therapies can truly disease modify at all. There’s a lot of grumbling disease, and it’s unclear whether we can stop long-term vascular issues. And in PMR, we have very little data on early therapy at all.
So what’s the justification?
#ACR23 @RheumNow https://t.co/spAMqfSOy2
David Liew drdavidliew ( View Tweet)
#ACR23 @RheumNow #GreatDebate
Treatment for PMR by Spiera
- Plan rapid GC taper. It is OK to flare, prepare pt!
- Low threshold to introduce anti-IL-6 for GC intolerance or AEs
No need for initial biologic treatment for PMR/GCA
@philseo rebuttal upcoming... https://t.co/A0f3b0fMOr
Eric Dein ( View Tweet)
Should IL-6i be first line in GCA/PMR? Dr. Spiera says steroids work, are cheap; no evidence of using IL6i early in disease. there had been cases where pts still had active vasculitis while on IL-6i. He starts with steroids first then add IL6i #GreatDebate #ACR23 @rheumnow https://t.co/Oq5Q9HFtW3
TheDaoIndex KDAO2011 ( View Tweet)
Cognitive function in PMR @DrTrishHarkins 71% cognitively impaired! Markedly higher than population level #ACR23 @RheumNow https://t.co/0KTnssktKz https://t.co/XyjFzioiqB
Richard Conway ( View Tweet)
Great work @sharoncowley01 https://t.co/llUF6REOFR https://t.co/Ej8fQlTNH0
Barry O'Shea ( View Tweet)
Fantastic presentation by @sharoncowley01 🚀
~1/5 patients with PMR have US evidence of Vasculitis at time of diagnosis without clinical signs of GCA
⬆️role of US in these patients https://t.co/wSs3IB8SU7 https://t.co/mAhFDVJJ8T
Caoilfhionn Connolly ( View Tweet)
PMR in the #ACR23 @US_FDA new approval update - not something you see every day!!
@RheumNow https://t.co/yll3d4AicK
David Liew drdavidliew ( View Tweet)
