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ORAL Surveillance - Is Statin Use the Problem/Solution?
The findings from ORAL Surveillance Study have been a dominant conversation at recent ACR Convergence, with the seminal findings and subsequent analyses a target of debate. Subsequent post-hoc analyses, follow-up studies, and claims data analyses have been used to further interpret the data, though a clear answer on safety is not certain. A study presented on Sunday reported on a new post-hoc analysis that provides new insights.
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Do pts w autoimmune disease (AID) respond differently to immune checkpoint inhibitors (ICI) & have different mortality or iRAE risk vs pts without AID?
Study of pts on ICI showed no significant difference in mortality in pts w & without pre-existing AID
Ab2532 #ACR24 @RheumNow https://t.co/suywDdGIB1
Mrinalini Dey DrMiniDey ( View Tweet)
Overall very reasonable, aligning ACR recs w/other guidance groups & updated data
Remember: guidelines are meant to be broken. Some patients can likely avoid pulse, others may need more steroid on the back end, biopsies are not benign
#ACR24 @RheumNow
Mike Putman EBRheum ( View Tweet)
Recommend "Triple Therapy" = Glucocorticoids + two other agents
Practically, that means MMF + belimumumab OR CNI for most pts
For the CYC afficionados, the lower-dose EUROLUPUS protocol is preferred
#ACR24 @RheumNow https://t.co/0gRISXSw0c
Mike Putman EBRheum ( View Tweet)
Happening now, new guidelines for mgmt. A few highlights:
Recommend prompt GC therapy, pulse x1-3d followed by oral pred (<0.5mg/kg/d) w/taper to <5mg by 6 months
Aligns with EULAR recs for a much-lower dose than most clinicians currently doing
#ACR24 @RheumNow https://t.co/B71i7FBYlQ
Mike Putman EBRheum ( View Tweet)
Abstract 2503: Clofutriben (HSD-1 inhibitor) minimizes adrenal suppression. Adding clofutriben to prednisolone boosts ACTH & cortisol levels with fewer patients with suppressed morning cortisol (≤5.0 mg/dL) (34% vs 14%).
@RheumNow #ACR24 #GCTox
Akhil Sood MD AkhilSoodMD ( View Tweet)
Low uveitis rates in patients with axial spondyloarthritis and psoriatic arthritis treated with bimekizumab (BKZ) over the long term.
Key findings:
- AxSpA: 3.7% incidence (1.3/100 PY) with BKZ.
- PsA: Only 0.2% incidence (0.1/100 PY).
- All events were mild/moderate, with no… https://t.co/jkUwHJk3FJ https://t.co/gTcCzeC88e
Links:
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Hyrich:
ETN originator vs biosimilar initiation
- DAS28 - no signif change at B/L, 6mo, 12 mo.
Switch?
Matched pts in ETN switch v cont originator - good b/l control on Rx
-DAS28 maintained w switch
10% did go back to originator, felt less good tho similar DAS
#ACR24 @RheumNow https://t.co/RHRit5CtUu
Links:
Eric Dein ericdeinmd ( View Tweet)
Early observational data suggesting JAK inhibitors can play a role in TAK tx
We have seen this with UPA in GCA this conference… time for SELECT-TAK !
@RheumNow #ACR24 https://t.co/B2Wa8sOFTp
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
Using longitudinal claims data, this study explores the safety of non-conventional combination targeted therapy in adults with psoriatic arthritis (PsA).
Key findings:
- 42,821 PsA patients analyzed; only 1.1% on combination therapy.
- Increased risk of serious infections:… https://t.co/Jghmz9lkLd https://t.co/YqwJlTKcEi
Links:
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Does adding a Clofutriben (HSD-1 inhibitor) w/ prednisone minimize the risks of steroid toxicities in #PMR patients?
VS placebo, PMR patients who received Clofutriben + Prednisone had substantial reductions in bone, lipid, and glycemic control parameters
@RheumNow #ACR24
Akhil Sood MD AkhilSoodMD ( View Tweet)
Does vasculitis flare with checkpoint inhibitors?
@MDAndersonNews experience:
17 stable pts
4 pts flared - all able to be controlled
(i.e. 13 didn't flare)
Encouragement that stable vasculitis pts that need ICI should get them!
#ACR24 ABST1986 @RheumNow https://t.co/jO4w3HWBMd
David Liew drdavidliew ( View Tweet)
Risks for HCQ cardiotoxicity:
👉>5 yrs use
👉>5 mg/kg/d (cumulative dose >500,000 mg)
👉CKD
👉use NSAID
👉preexisting heart dz
👉presence of ocular, derm, SkM toxicity
- Dr M Garschik #ACR24 @rheumnow https://t.co/LFobgls4jm
Links:
TheDaoIndex KDAO2011 ( View Tweet)
Dr. @karen_kc123 discusses the results of the VITAL study.
- Long term use of Vit D3 2000IU was safe and decreased the incidence of all autoimmune dses by 22%.
- It took a while to work but the effect dissipates once discontinued.
@RheumNow #ACR24
@rheumarhyme https://t.co/mnwRsdZ06N
Links:
sheila RHEUMarampa ( View Tweet)
Study of 25K+ patients using TrinetX on immune checkpoint inhibitors shows no significant mortality difference between those with pre-existing autoimmune disease (AID) and those without.
Mortality rates:
AID: 39.8%
Non-AID: 40.2%
Large-scale evidence supports ICIs in AID… https://t.co/BI5jK9jsoM
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
A#2532
Pre-existing AID for immunoRx?
Excluded from trials
4 prior studies showed no diff in mortality w AID
Propensity-matched cohort study
Followed median 250 days
Hazard ratio: 1.07 (unmatched), 0.97 (matched) - no diff. Mortality about 40% in grps
@RheumNow #ACR24 https://t.co/zyVCPts6s6
Links:
Eric Dein ericdeinmd ( View Tweet)
In earlier studies of Vit D, there were conflicting evidence as to whether it reduced or increased the risk of RA and #SLE
@RheumNow #ACR24 @rheumarhyme https://t.co/PvjjmhHaOd
sheila RHEUMarampa ( View Tweet)
Gottenberg et al. A positive RCT in pSS! DAHLIAS study. Phase 2. 163 patients. Nipocalimab, anti-neonatal Fc receptor (FcRn) mAb. @RheumNow #ACR24 Abstr#2527 https://t.co/M7li4ZoKeY https://t.co/gV9MGnswdR
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Richard Conway RichardPAConway ( View Tweet)
Nipocalimab, an anti-neonatal Fc receptor (FcRn) mAb, reduces circulating IgG including specific autoantibodies (AAb), by selectively blocking IgG–FcRn interactions.
DAHLIAS, the first study of a FcRn blocker in SjD, showed that nipocalimab led to significant improvement vs PBO… https://t.co/zl1tEsEMAj https://t.co/qrkOD2Ccc3
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Antoni Chan MD (Prof) synovialjoints ( View Tweet)
A#2527 DAHLIAS, P2 Nipocalimab: Anti-FcRn Ab in Ro+ SjD IV 5 or 15 mg/kg Prim Endpt: 15 mg/kg has ClinESSDAI at w24 -6.4 v -3.7 PBO p=0.002 Improv dryness, fatigue, pain Better unstim salivary flow Best response in higher Ab titer pts Safety data good #ACRBest #ACR24 @RheumNow https://t.co/O7zahPul66
Links:
Eric Dein ericdeinmd ( View Tweet)
