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Playing it Safe with RA? JAK vs. TNF Debate
Reported safety signals, at odds with the efficacy of these medications, have left rheumatology clinicians in a difficult position when considering when during a patient’s treatment course and in which patients, specifically, JAKi should be used. Two abstracts from ACR convergence 2024 further contribute to our understanding of this potential risk profile.
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ACR 2024 - Day 3 Report
Highlights from Day 3 at ACR24 included the plenary session presentation on Nipocalimab (previously reviewed), but the big highlight was the Lupus Nephritis guideline recommendations.
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JAKs and Other Drugs in PMR
This has been an interesting ACR meeting in terms of PMR updates. I would argue that we are still far too wedded to glucocorticoids only in the management of PMR. Yes, some patients will do fine with just glucocorticoids but we persist far too long with a glucocorticoid only strategy in others who clearly need an alternative as glucocorticoid adverse events multiply.
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In this study by Dr CArriens et al, there was no difference between the vaccine response to Influenza by either HAI or Ab levels in Anifrolumab-treated pts.
AEs - mild, moderate
No serious aEs
💉#vaccinate your pts on anifrolumab with influenza
@RheumNow #ACR24 abs2424 https://t.co/XPwlzUS02i
Links:
sheila RHEUMarampa ( View Tweet)
Mortality Risk After Stopping Glucocorticosteroids (GC) in RA.
In a study of 28,078 RA patients:
Mortality risk from CVD ↑ 7.5%/year of GC use; ↓ 1.3%/year after stopping.
Mortality risk from infections ↑ 6.8%/year of GC use; ↓ 4.9%/year after stopping.
Risks normalize 1.5–10… https://t.co/i6cKet1EEV https://t.co/ClMjIly20E
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Antoni Chan MD (Prof) synovialjoints ( View Tweet)
VACIMRA Study showed timing matters for Methotrexate and Pneumococcal Vaccine in RA.
RA patients vaccinated with PCV13 1 month before MTX initiation had higher responder rates at 1 month:
88% (ELISA) vs. 75%
96% (OPA) vs. 88%
At 12 months, responses remained stronger in… https://t.co/bSbIazsRtG
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Hydralazine - known culprit of drug-induced AAV
How does hydral (H) AAV differ from primary (1) AAV?
💥 High dual positivity MPO/PR3
💥 DAH / pleuritis more common in H-AAV
💥 ENT, constitutional, nervous, ILD in 1-AAV
💥 More 6mo remission in H-AAV
@rheumnow #ACR24 Abst 2496
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
Severe thrombocytopenia (TP) is rare but linked to major organ involvement and poor prognosis in #SLE. Data from the RISE registry shows TP in 9.3% of SLE patients, with higher prevalence in males, African-Americans+ those with multiple comorbidities.
#ACR24 @RheumNow abst#2680
Bella Mehta bella_mehta ( View Tweet)
In prelim analysis of this controlled clinical trial, SLE pts w/ active dse who weres given addtl NAC for 3 mos had significantly reduced dse activity.
Mechanism? NAC reduces rapamycin (mTOR) activation.
Common AEs: nausea, vomiting
@RheumNow #ACR24 abs2677 https://t.co/E4w2Qd7RwP
Links:
sheila RHEUMarampa ( View Tweet)
LEVI-04 a novel neurotropin3-i showed:
-significant analgesia across all measures
-improvement in functional measures and PGA for all doses in a Ph2 RCT
- well tolerated
Hopefully will prove to be a therapeutic option for knee #osteoarthritis in future
@RheumNow #ACR24 absL15 https://t.co/kWsyyyGxyU
sheila RHEUMarampa ( View Tweet)
PHOENYCS GO, RCT of dapirplizumab, novel CD40Li in SLE
Met primary endpoint (NNT~6 for BICLA) & numerical improvements in many other endpts
1 MI & 1 death from infection over 213 pts
Encouraging for sure! Second phase 3 being launched
#ACR24 @RheumNow Abstr#L16 #ACRbest https://t.co/QwDMKjhFvb
Links:
Mike Putman EBRheum ( View Tweet)
#MDA5 #dermatomyositis assoc #ILD
May do better w
#tofacitinib vs #CNI in 515 pts
Too bad they didn’t do a pragmatic RCT as we do t know the reasons for prescribing each #Rx
But impressive survival w #tofa
#ACR24 @ACRheum @RheumNow abst1736 https://t.co/HLJknSYcNJ
Janet Pope Janetbirdope ( View Tweet)
Lot said about #ACR24 ABST1697:
MTX in newly diagnosed PMR, neg RCT
Many have said no hope for MTX in PMR now
Agree doesn't bode well
However, MTX may still have role in established PMR
@drceowen & I have made that call a priori @TheLancetRheum https://t.co/ywCJc0zHzC
@RheumNow https://t.co/JUXk2tDNyR
Links:
David Liew drdavidliew ( View Tweet)
It is NO LONGER a ACCEPTABLE
To NOT consider
#MMF or #Cyclo + another proven #Rx
Added to
#HCQ and #tapering /limiting #glucocorticoids
RCTs in #lupus #nephritis support this
? Is which to add
#belimumab
#CNI #volclosporin
#obinutuzimab
#ACR #ACRbest @RheumNow @ACRheum https://t.co/a7WMFfCyXl
Janet Pope Janetbirdope ( View Tweet)
TNFis preventing cancer compared to placebo, and JAKi being neutral to placebo and maybe preventing haem cancers also. #ACR24 abstract 0989 was certainly provocative. I've shared my thoughts on @RheumNow https://t.co/yQFoUGifEN
Richard Conway RichardPAConway ( View Tweet)
Potential Impact of Weight Loss Drugs in Rheumatic Diseases
Dr. Arthur Kavanaugh highlights a session regarding weight loss and improvement in disease outcomes, specific weight loss drugs (SGL-2 and GLP-1), along with downsides when patients stop these medications. Reporting… https://t.co/Ilu2FXK2xi https://t.co/7CKSnfuey4
Dr. John Cush RheumNow ( View Tweet)
A#2651
Vasculitis w VEXAS
81 men, median age 67 - 27% had evid of vasculitis, variable size vessel
22% SVV- 17/18 cutaneous, one peritubular capillaritis on renal bx
2.5% MVV (2 cutan), LVV (2 carotid thickening, 1 had +TA bx), ANCA+
@RheumNow #ACR24 https://t.co/puablIBLCP
Eric Dein ericdeinmd ( View Tweet)
What factors are assoc with uptake of newer meds in RA?
➡️Incr use of b/tsDMARDs over 10yrs
➡️Use of newer drugs lower in older ppl, socioeconomic deprived & Asian/Black ppl
Could this indicate disparities in access to meds? How can we best address this?
Ab2608 #ACR24 @RheumNow
Mrinalini Dey DrMiniDey ( View Tweet)
A#2652
NEWTON study 🇫🇷 Retrosp cohort
51% relapse. Median @8.7 mos, dose 9mg pred
Rf: limb art involv- HR 1.9
Pred taper speed not risk for relapse
Most relapse -> incr GCs
Toci 1/3 at dx, 50% stopped
-61% d/c due to remission, 39% SEs
-1/3 relapse after d/c
@RheumNow #ACR24 https://t.co/NP0wieDmvo
Eric Dein ericdeinmd ( View Tweet)
Peyrac et al. 211 GCA. Relapse in 52% at median 261 days (so 1st year). 83% on GCs at relapse, median dose 6.5mg pred. 36% relapse post-toc discontinuation, at median 133 days. 64% no relapse when toc stopped, at median 511 days @RheumNow #ACR24 Abstr#2652 https://t.co/NqtdDNGGoc https://t.co/mXD8x7O6Ww
Links:
Richard Conway RichardPAConway ( View Tweet)
