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Day 2 Report - ACR Plenaries: Changing the Practice of Rheumatology
Over the years of navigating the annual meeting, I found the sessions with the most impact to my practice were the Plenary Sessions. During these sessions, the latest research is presented, new ideas are floated, and old myths debunked. Here are the top ACR2023 Plenary abstracts I found impactful for my practice.
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SGLT2 inhibitors: The new hype in SLE and LN management?
Inhibitors of SGLT2 have been shown to reduce MACE in patients with type 2 DM and established cardiovascular disease. In patients with chronic kidney disease at risk of progression, SGLT2 inhibitors have shown reduction in risk of eGFR decline and hospitalization. In SLE, clinical trials have yet to explore the possible role of SGLT2i in improving renal outcomes in lupus nephritis. A couple of abstracts presented during the meeting tackled the topic of SGLT2 inhibition in SLE.
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#ACR23 Late-Breaking Abstr#L13 CAR-T is in CT but not RCT yet. Preliminary results from open label (N=3 #SLE of YTB323 (rapcabtagene autocel CD19 directed with preserved T cell stemness) showed favourable CAR T expansion, B cell depletion, early efficacy & safety @RheumNow https://t.co/UQUOfDbFJe
Md Yuzaiful Md Yusof ( View Tweet)
A#2316 #ACR23 @RheumNow
91 SLE pts w COVID v 182 SLE wo COVID ifn
11 SLE/COVID: serious disease
1 death, 7 severe compl
W/in 90d, 15% mild/mod SLE flare 2% severe SLE flare
Flare rate 17.6% higher than no COVID ifn 5% p=0.001
High HV ifn (2% v 1%)
dsDNA/C3 changes not signif diff https://t.co/dxGJNNWuFy
Eric Dein ( View Tweet)
A#2313 #ACR23 @RheumNow
Utilization of inpt palliative care incr from 2016-2020 in SLE admits from 1.8% 2016 to 2.6% 2020
Pall care use incr: older pt, comorbid index, teaching, large hosps
Lower use: age <35 yo, Black & Hispanic race
Need to address racial disparities in utiliz https://t.co/wQ8NOhm9lK https://t.co/3tJgt4MMDf
Eric Dein ( View Tweet)
@EricFMorand SPOCS Study: A#2263 @ACR23
826 pts - 71% high IFN gene sig
Mean SLEDAI-2K lower with low IFNGS
6mo: pts reports 1+ flare 19% high IFNGS, 16% low. Both grps 6.7% LLDAS, but remission 4% low/1.7% high
In 36 mo, <10% LLDAS, <10% remission
@earlyARA @RheumNow https://t.co/z5v4TBVuDG
Eric Dein ( View Tweet)
Post hoc analysis of Ph2 AURA-LV & Ph3 AURORA1
⬆️VOC-treated pts achieved CRR at 1yr vs. control arm (41.0% vs. 21.9%; OR 2.48, p< 0.0001) and PRR at 1yr (OR 2.3, p< 0.0001)
Similar safety profiles
VOC: Additional tx option for LN pts w/ UPCR >/=2g/g
#ACR23 ABST2326 @RheumNow https://t.co/9z1n3s7umU
sheila ( View Tweet)
A#2297 #ACR23 @RheumNow
Baseline IFNα predicts complete response at 2 yrs in LN
HIgh IFNα: incr risk of 2+ renal flare
Increase of 1 unit of IFNα incr risk of 2+ flares by 35% & risk of decr GFR
IFNα cutoff 0.6 for 2+ flare, 1.3 for progr to eGFR <15
AUC 0.6 (weak predictor) https://t.co/FKeDJVNyYj
Eric Dein ( View Tweet)
HCQ improves complements
A#2327 #ACR23 @RheumNow
Petri @jhrheumatology @andreafava
Pts w/ low complement & low HCQ levels
In pts who increased HCQ WB level >50 ng/mL, incr in mean C3 (p=0.02) v HCQ that did not incr
More nml C4 levels (p=.003) and incr mean C4 (p=.004) on HCQ https://t.co/J7PIuaRTO8
Eric Dein ( View Tweet)
HCQ Discontinuation
A#2343 #ACR23 @RheumNow
42 pts d/c HCQ
19% flared in past yr before d/c
D/c reasons: retina tox 57%, self-dc 17%, other eye issue 12%
26% flare in yr after d/c - strongest ass for flare: mean C3, dsDNA+ at index visit https://t.co/d4TqneS46u
Eric Dein ( View Tweet)
The patients’ voice matters! Watch my interview with @LAlupusLady regarding how she manages #Lupus and her perspective about the disease @rheumnow #ACR23 @uptoTate https://t.co/P9KPJQEkRv
TheDaoIndex KDAO2011 ( View Tweet)
@Bweber04 on recurrent pericarditis especially some seen in our lupus population
IL-1 inhibition with Rilonacept really redefining treatment success and altering the typical treatment algorithm
@RheumNow #ACR23 https://t.co/Ey1DN8eSXT
Robert B Chao, MD ( View Tweet)
Prelim data supports further evaluation of YTB323 in srSLE. #ACR23 Abs L13 reviews safety, CAR-T cell expansion, B cell depletion and initial efficacy in 1st 3 pts. https://t.co/aOLMhBBjgY @rheumnow https://t.co/2BoNeMe3Tg
Dr. Rachel Tate ( View Tweet)
Summary of diet effects in RA and SLE patients 👇
Dr. Sarah Patterson also shared nutrition resources for pts and clinicians
https://t.co/ae6nLrLXca
#ACR23 @Rheumnow @rheumarhyme @GerRheumDoc @doktora_ging https://t.co/8HhCHCTGLh
sheila ( View Tweet)
I got a chance to interview first author Jun Chu @nihrheumatology for her study on GnRHa Reducing Premature Ovarian Insufficiency in SLE pts on CYP. Watch here @RheumNow #ACR23 https://t.co/VCvAiRs4ni
TheDaoIndex KDAO2011 ( View Tweet)
Great summary of the big takeaways yesterday at #ACR23. Always love talking to @KDAO2011 @EBRheum @RheumNow
We get into the use of MTX, the safety on TNFs and what is in the purview of rheumatology practice https://t.co/jm0a8ndrsi
Eric Dein ( View Tweet)
Some studies addressing fish oil supplementation in patients w/ SLE
Showed improvement in disease activity but not in serologic activity
#ACR23 @RheumNow https://t.co/ANf8yMUd1b
sheila ( View Tweet)
What could CAR-T therapy mean for pts? Dr. Schett reviews 8 SLE pts, data collected since 2021 post 1 CAR-T treatment, & their marked improvement/remission of symptoms by classification criteria. Currently, he is studying a total of 15 pts (SLE, SS, myositis) #ACR23 @RheumNow https://t.co/MyMcF3PwiP
Dr. Rachel Tate ( View Tweet)
In case you missed it! Watch our ACR Monday Recap of the meeting with me, @RheumNow @EBRheum and @ericdeinmd. #ACR23 @uptoTate https://t.co/GpMdev0Yk7
TheDaoIndex KDAO2011 ( View Tweet)
Early experience w/SGLT2i in SLE (Prof Petri):
👉Reduction of decline in eGFR after SGLT2i
👉Improvement in RUPCR after SGLT2i
BUT observed differences not significant when compared w/prior to starting SGLT2i
Small sample size. Longer ffup needed.
#ACR23 ABST1490 @RheumNow https://t.co/IhVFacRi0g
sheila ( View Tweet)
