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The Heart of Lupus
Few people are aware of the EULAR recommendations for cardiovascular risk management in SLE published in 2022. The recommendations had 4 overarching principles: increase awareness of elevated cardiovascular risk, need for regular cardiovascular screening, assess and manage modifiable risk factors, and patient education. During ACR 2023 Convergence, several abstracts were presented evaluating the prevalence of CV disease and exploring new tools to predict CV disease.
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#ACR23 Abstr#0785 So many debates re: HCQ dose 5mg/kg/d vs 6.5mg/kg/d - could blood monitoring help? A cohort study showed HCQ levels 750-1100 ng/mL was associated with reduced risk of #lupus activity by 76-90%. Need validation & assoc with retinal toxicity risk @RheumNowNews https://t.co/oRCHUG2dVA
Md Yuzaiful Md Yusof ( View Tweet)
#ACR23 Abstr#0548 Is there a risk prediction tool to help exclude non-immune pathology for Rheumatologists with newly referred ANA+? 3-yr data showed 3 BL markers: IFN score B, criteria No & FH of RMD had 98% specificity. Cd help inform early Tx trials in High Risk @RheumNowNews https://t.co/DCAg4EwM9d
Md Yuzaiful Md Yusof ( View Tweet)
Or to quote the great Murray Urowitz @UHN "a #lupus pregnancy has four trimesters"! #ACR23 https://t.co/Iw2S81tiTH
Ian N Bruce ( View Tweet)
✅ Question to YOU attending #ACR23 ➡️ We're almost at the end of 2023 ⌛and many great #lupus data are being presented at @ACRheum Convergence 2023 in San Diego 👍 What would YOU update/change 🔄 regarding the management of #lupus in 2024 compared to 2023? 🧭 https://t.co/xpSXjuDjyr
Laurent ARNAUD ( View Tweet)
ARDs increase risk for CVE in pregnancy, the highest being APS, SLE (with LN and APS) and RA. Close monitoring not only during but also after pregnancy is required. #Plenary #ACR23 https://t.co/W3CSjccSno
Adela Castro AdelaCastro222 ( View Tweet)
Pregnant women with ARDs esp. SLE nephritis and primary APS have significantly higher risks for acute CVEs compared to those without these conditions. 25-30% of CVEs occurred during the postpartum period, Dhital R Abst#0722 #ACR23 #ACRBest @RheumNow https://t.co/m9FjsAu64N https://t.co/1dyTzgH97A
Dr. Antoni Chan ( View Tweet)
Urinary biomarkers precede loss of kidney fxn in LN by @andreafava
#Ab0850 @RheumNow #ACR23
73 pts w LN. 44% devel GFR loss
Elevation of urinary biomark of histo activity at 6, 12 mo predict GFR loss at 3 yrs - esp IL-16, >> proteinuria
Combo biomark 12 mo: AUC 0.95
#ACRBest https://t.co/M7sfpCm7Kz
Eric Dein ( View Tweet)
AI predict ANA specific Abs? @AliDuarteMD
Ab#0852 #ACR23 @RheumNow
410K pts test for ANA HEp-2 IFA (136K pos, 47K specific autoAb)
AI prediction models >0.80 AUC exc for RNP, Scl70
More predictive than traidtional staining patterns (p<0.001), except centromere (similar) https://t.co/4ZvP79rEdl
Eric Dein ( View Tweet)
Results of this study by Dr Fava show that most urinary BMs of histological activity were⬆️at 6 & 12mos in pts who lost GFR at 3yrs.
☝️Some LN pts still develop renal damage despite clinical response. Is there a role for BMs in monitoring tx?
#ACR23 ABST0850 @RheumNow #ACRbest https://t.co/H5G6LJ22lw
sheila ( View Tweet)
IFN 5-gene signature to ID high IFN subsets as biomarkfor DEUC in PAISLEY P2 SLE trial
Ab847 #ACR23 @RheumNow
IFN 5 gene score - 78% IFN-high pt
IFN high ass w SLEDAI-2K, CLASI, PGA, dsDNA, low C3/C4/lmphocyte
DEUC reduc IFN 5 gene score in both grps, best clin response in IFN hi https://t.co/WpZHE5z8za
Eric Dein ( View Tweet)
Ab#0848 @RheumNow #ACR23
Biomarkers to Differentiate Flare from Bacterial Ifn in SLE
CD14 and CD64 modest increase in infections v flare, better than IL-6 and MRP8/14
One marker not enough to differentiate, but in combo w/ complements, procal, dsDNA improves composite scores https://t.co/MeMYbkMTQH
Eric Dein ( View Tweet)
The belimumab-rituximab combination has utility in SLE, but it comes at an incremental safety cost.
May well be worth it in many of our patients, but very understandable that the @US_FDA label gets further clarification
#ACR23 @US_FDA session @RheumNow https://t.co/RwF2wbsrQk
David Liew drdavidliew ( View Tweet)
#ACR23 Abstr#0782 Triple therapy in #lupus nephritis. Propensity match data AURORA vs ALMS showed pts treated with voclosporin+MMF+low dose GC vs MMF+High dose GC achieved earlier reduction in UPCR & fewer AEs. Cdnt control for everything e.g. HCQ but assuring @RheumNow #ACRBest https://t.co/dmriAyQPr0
Md Yuzaiful Md Yusof ( View Tweet)
What do you think of CAR T Rx in severe #SLE? @RheumNow @ACRheum #ACR23
Janet Pope ( View Tweet)
Ab#0596 #ACR23 @RheumNow
R Furie on Decravacitinib in SLE
48wk double-blind trial. PBO v DEU 3mgBID, 6 mgBID,12 mg qd
Higher response, faster time to SRI(4), BICLA and dual response v PBO. More likely to sustain response from w32-48. https://t.co/M34d3nQmwv
Eric Dein ( View Tweet)
LEGACY Cohort - Rx monitoring AZA/Tacro in SLE pregnancy
Ab#0586 #ACR23 @RheumNow
70 pregnancie. 33% prescribed AZA, 9% TAC
AZA - 91% subtherapeutic or non-adherent
More likely in non-Caucasian, on steroids, longer SLE duration, prior lupus nephritis
TAC - 3/6 therapeutic levels
Eric Dein ( View Tweet)
Targeted OX40L (co-stimulatory APC protein w/ possible polymorphisms in SLE) study by Womba et al, found OX40L targeted CAR-Tregs had superior in vitro suppression of activated T cells & dendritic cells relative to Control-Tregs. #ACR23 Abs 0799 https://t.co/GgCGGIvhHF @rheumnow https://t.co/GZMEUCTooh
Dr. Rachel Tate ( View Tweet)
Should the cost of #CAR-T stop us from considering in severe refractory #lupus? So far update of German group show remission - drug free and great safety. But hold on..we need RCTs with an active control and longer f/u, but I am impressed! #ACR23 #ACRbest @ACRheum @RheumNow #784 https://t.co/mRMWLCbpCY
Janet Pope ( View Tweet)
