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ACR21 – Day 3 Report
Hitting the home stretch, day 3 presentations were big! Here are a few of my favorites: secukinumab efficacy in juvenile PsA; VEXAS - predicting poor outcomes; and the FDA Safety Update session.
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Monitoring Infliximab Drug Levels Improves Efficacy
Should we start considering therapeutic drug monitoring when prescribing TNFi for treatment of our rheumatologic conditions?
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NOR-DRUM B: infliximab therapeutic drug monitoring (TDM) vs standard of care (SoC)
Goal inflix. level 3.0-8.0mg/L
🔹axSpA, PsA, PsO, RA, UC, Crohns
🔹Dose⬆️or⬇️based on how level & +/- inflix-Ab
🔹Proactive TDM superior
https://t.co/BHQwJSVHxD
#ACR21 Abst#1946 @RheumNow #ACRBest
Pedro Castillo _Castillo_Pedro ( View Tweet)
Oh, also VTEs. Not designed to do this, but:
- We don't use 10mg bid & we shouldn't start
- 5mg bid looks just fine
- In fact, in patients with a VTE history, 5mg bid is numerically similar (?better) to TNFi
Somehow, VTE in tofa is an overshadowed non-event!
#ACR21 @RheumNow https://t.co/fvMSg49kk6
David Liew drdavidliew ( View Tweet)
So today the full NOR-DRUM B details - the first positive RCT for TNFi TDM in rheum
HR 2.09 for worsening with standard care (clinician discretion) vs proactive TDM (change before clinical issue)
Open label, but this is a lot better than guessing!
#ACR21 ABST1946 @RheumNow https://t.co/kyKh00ARVW https://t.co/uW6vYHLI7Y
David Liew drdavidliew ( View Tweet)
Different drugs may target different pathways in PsA!
S-cell proteomic biomarkers in SELECT-1 PsA study:
💥UPA targets ▶️ Adaptive immunity, bone metabolism pathways
💥ADA targets ▶️ innate immunity pathways.
Paving the ground for personalised therapy?
#ACR21 #Abst1816 @RheumNow https://t.co/hyMP4PtUnM
Aurelie Najm AurelieRheumo ( View Tweet)
An artificial neural network for detection of radiographic #sacroiliitis in axSpA? @DrPoddubnyy
📌Specificity - 93.9%
📌Sensitivity - 78.7%
Potential tool for interpreting SIJ in nonspecialized ctrs or clinical trials
This is a game changer!🤓
@RheumNow #ACR21 #ACRBest abs1919 https://t.co/2li0dNWtLc
sheila RHEUMarampa ( View Tweet)
And it’s a wrap!! Time for a pool game🎱 Delighted to have been reporting for @RheumNow alongside an amazing faculty! and delighted to have been able to be around amazing colleagues to attend #ACR21 convergence! See you all next year, hopefully for real! 🤞🏼 https://t.co/JBoKd7zNvl
Aurelie Najm AurelieRheumo ( View Tweet)
Abstr 1677
Miwa & colleagues studied the effect of bDMARDs on cholesterol levels in RA patients
- bDMARDs may affect HDL levels
- no significant effect was seen on LDL
#ACR21 @RheumNow https://t.co/yb35HMDlxN
Akhil Sood MD AkhilSoodMD ( View Tweet)
Bridging the gap in the delayed diagnosis of axSpA
Dr. Swetha Ann Alexander ( @swethaann23 ) shares the findings from several abstracts presented at #ACR21.
https://t.co/8eEXIbyopA https://t.co/brtaZztRhl
Links:
Dr. John Cush RheumNow ( View Tweet)
RheumNow’s expanded coverage of the #ACR21 annual meeting is sponsored in part by @bmsnews, @JanssenUS, @Novartis. All content chosen by RheumNow and its faculty.
Dr. John Cush RheumNow ( View Tweet)
Increased Risk of MACE in Lupus After Noncardiac Surgery: Dr. Kathryn Dao ( @KDAO2011) discusses abstract #0128 presented at #ACR21 annual meeting.
https://t.co/HOVLrhBbuu https://t.co/MAItCSHMIb
Links:
Dr. John Cush RheumNow ( View Tweet)
#ACR21 Ab#1941: ORAL Surveillance VTE risk
▶️Tofa 10 BID risk > 5 BID > TNFi for VTE, DVT, PE
▶️Age, male, obesity, HTN, h/o VTE, oral contraception/HRT, steroids, antidepressants were risk factors
@RheumNow
https://t.co/JOKNyYVZfX https://t.co/mTkgkwPIT6
Links:
Eric Dein ericdeinmd ( View Tweet)
Comparative risks of skin SCC and BCC with different DMARDs. Abatacept appeared worst, HR 2.18, but may be residual confounding due to burden disease/comorbidities. Abstr#1942 #ACR21 @RheumNow https://t.co/UzOwuKKFmX
Richard Conway RichardPAConway ( View Tweet)
Therapeutic drug monitoring ⬆️ infliximab efficacy in RCT. 17.6% improvement in sustained disease control. Consistent across all rheumatic and non-rheumatic diseases. Abstr#1946 #ACR21 @RheumNow https://t.co/D1Ppb58fB8
Richard Conway RichardPAConway ( View Tweet)
Who declines most with #scleroderma #ILD - early dcSSc, ⬆️CRP, ⬆️mRSS all w more ⤵️FVC. Results verified in SENSIS trial of SSc ILD where #nintedanib was superior to placebo abst#1846 #ACR21 @RheumNow https://t.co/eckUj0qwch
Janet Pope Janetbirdope ( View Tweet)
Thank you @AhmadSherbini for discussing his #ACR21 research on @RheumNow on Abs#1444 - Can we predict which patients are most likely to have nausea or alopecia intolerance to MTX?
https://t.co/I5WmCECq7v
Eric Dein ericdeinmd ( View Tweet)
GRA @rheum_covid data presented by @mugartegil. African-American and Hispanic individuals with SLE have MUCH worse COVID-19 outcomes. Likely related socioeconomic and health disparities. Abstr#1933 #ACR21 @RheumNow https://t.co/YUoOeIxN7O
Richard Conway RichardPAConway ( View Tweet)
Hospitalisation for heart failure ⬆️ in inflammatory diseases. RA>PsA>AS>PsO . HRs 1.1-1.6 compared to general population. Abstr#1925 #ACR21 @RheumNow https://t.co/kKlGQM5Tcg
Richard Conway RichardPAConway ( View Tweet)
#ACR21 Ab#1939: Tofa CV Outcome (STAR-RA)
▶️Pooled data does not show ⬆️ risk of CVD
▶️Trend in pts w prior CVD -HR 1.27 (0.95-1.7), cannot r/o CVD risk in pts w risk factors
Less clear than oral surveillance data, but concerns in those w risks
https://t.co/JOKNyYVZfX @Rheumnow https://t.co/GGYJfxcqhc
Links:
Eric Dein ericdeinmd ( View Tweet)