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FAST, FREED, CARES, & CONFIRMS: A Run-Down on the Black-Box Blues of Febuxostat
Febuxostat, a nonpurine xanthine oxidase inhibitor used in the treatment of chronic gout to lower serum urate levels, received bad press in 2019 after the US Food and Drug Administration (FDA) placed a black-box warning on the medication’s label suggesting that it increases the risk of cardiovasc
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#ACR20 Abstracts on #ILD
Rituximab in ILD (all observational)
#1053 ➡️ 47 with CTD-ILD: overall improvement or stability at 36m
#1051 ➡️ 50 with IPAF: >70% stable or improved at 12m
#1047 ➡️ 47 patients CTD-ILD or IPAF: good experience with MMF and RTX
#ACRambassador https://t.co/klfVwIH5b6
Sebastian E. Sattui MD, MS SattuiSEMD ( View Tweet)
Latebreaking at #ACR20—Febuxostat was non-inferior to allopurinol with regard to the occurrence of major cardiovascular outcomes in patients with gout: finding from FAST, multicentre, prospective, randomised, open-label, non-inferiority trial https://t.co/cpoNi7zjwi https://t.co/uQyeyepPmj
Links:
The Lancet TheLancet ( View Tweet)
The FAST trial had 33% of pts with CVD and pts w/class III/IV CHF were not allowed in this study (vs. CARES trial where all subjects had baseline CVD); I am still cautious prescribing febuxostat to pts who have severe CVD until we have more data. @RheumNow https://t.co/fJ9bLcXpR2
k dao KDAO2011 ( View Tweet)
IN GOUT: CARES study said febuxostat increases CV risk; Todays FAST study says No incr CV risk w/ FEB. In your Gout pt w/ CV hx, would you use febuxostat? #ACR2020
Dr. John Cush RheumNow ( View Tweet)
FAST trial (Plenary) showed opposite of CAREs study. Febuxostat vs PBO in 6128 Gout pts, showed little dropout (~6%) in a 4 year study. Febuxostat (mean 81mg) had similar, flare rates, MACE/cardiac endpoints and CV death vs allopurinol #ACR20 Abstr#L08 https://t.co/FkdDtPB4Oi https://t.co/J9KonQHpT2
Dr. John Cush RheumNow ( View Tweet)
A large observat study showed no difference in risk of major CV events in RA pts that were newly started on either MTX or HCQ. A greater stroke risk but lower risk of MI & hospitalized HF was seen in MTX initiators. #Abst1993 #ACR20 @RheumNow
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
Abatacept in RA and ILD Patients: Dr Richard Conway (@RichardPAConway) #ACR20
https://t.co/e31VsnXFq5 https://t.co/sCrqLtXFFc
Links:
Dr. John Cush RheumNow ( View Tweet)
#ACRbest Largest to date cohort study of pregnancies in women w/ ILD showed no maternal deaths suggesting that women w/ ILD may not need to avoid conception or terminate pregnancies, but pts w/ severe ILD were at higher risk for poor pregnancy outcomes. #Abst1446 @RheumNow
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
Poll results are in! 75% of those that responded plan to only screen for cardiac manifestations of myositis if a pt develops concerning symptoms. 20% screen for involvement annually w/ a TTE, troponin, BNP, and EKG! @RheumNow #ACR20 https://t.co/crUhFR6Hzf
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
@RheumNow #ACR20 abs1151 screening for inflammatory hyperferritinemia may be feasible but requires additional info: inflammatory huperferritinemia more likely to correlate with ⬆️IL18, AST&thrombocytosis while high CRP+ferritin more often seen in infectious etiology https://t.co/wiFPXepxpz
Olga Petryna DrPetryna ( View Tweet)
Can hs-troponin and hsCRP predict future major cardiovascular events? Certainly appears so in RA pts (n=636).
To what extent do subclinical dx and inflammation combine to cause future RA CV pain?
PRECISION trial subgroup @ElaineHusniMD @DanielHSolomon #ACR20 ABST1189 @RheumNow https://t.co/ZYTpodatVI
David Liew drdavidliew ( View Tweet)
The lung-joint axis in RA just keeps on getting stronger
Lung ACPA present in early untreated RA/CSA:
crossreact acetylated/carbamylated antigens
differ in effects on cell types (neut activation, fibroblasts, osteoclasts)
Isn't lung ACPA fascinating?
#ACR20 ABST1445 @RheumNow https://t.co/9VKSRYlndT
David Liew drdavidliew ( View Tweet)
National Inpatient Sample claims: ANCA Assoc vasculitis pts hospitalized with acute MI (AMI) had a no increase in mortality rate (5.3% vs. 4.7%) during 2016-2017, suggesting potentially better control w/ new meds (RTX), less steroids #ACR20 Abstr#1424 https://t.co/TYELUAjm9d
Dr. John Cush RheumNow ( View Tweet)
821 SLE pts from Hopkins lupus clinic showed that LAC was best predictor of venous + arterial thromboses. β2glycoproteinI IgA (+) also important! #ACR20 #Abstr#1261 https://t.co/H0hz9Gp5Hy https://t.co/Vpiih4LyuZ
Dr. John Cush RheumNow ( View Tweet)
In our quest to reduce delays to diagnosis in axSpA, this paper in patients with psoriasis, AAU and IBD, the ASAS-modification of the Berlin algorithm was superior to the original algorithm, with enhanced sensitivity @RheumNow #ACR20 Abstr#1303
Dr. Antoni Chan synovialjoints ( View Tweet)
NT-proBNP and TnI predicted cardiovascular events in patients with PsO or PsA. Abs#1328
Do you measure/monitor for cardiovascular disease in your psoriatic patients?
@RheumNow #ACR20
Robert B Chao, MD doctorRBC ( View Tweet)
Nintedanib in rheum ILD (RA/SSc/CTD)
I appreciate the volumes might not seem like much, but:
- in first 1y Rx 20% more are spared a FVC decline>10%
- biggest diff in UIP-like pattern
With the right patient selection, nintedanib does have its place!
#ACR20 ABST1048/1049 @RheumNow https://t.co/jGZdR84bBU
David Liew drdavidliew ( View Tweet)
So much more work to be done- the traditional tools for estimating CVD in rheumatic patients are likely not accurate especially patients with SLE- abstract 1286 @RheumNow #acr20 https://t.co/L6Z1fsO2he
alexa meara lexmeara ( View Tweet)
#sjogren #syndrome poster session #ACR20 @RheumNow Clinical characteristics: lung, pregnancy,smoking, cervical lesions, anti La, childhood. https://t.co/QN4FVvQrYN
Sole RetamozoSole ( View Tweet)
