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Addressing CV Risk in RA: Are we doing enough?

Mrinalini Dey, MD

ORAL surveillance was a post-authorisation safety study of tofacitinib 5mg and 10mg versus TNF inhibitors, focusing on rates of adverse events, including MACE. A higher incidence of MACE was observed with the use of tofacitinib. Statins are recommended in patients with a history of atherosclerotic disease or 10 year predicted risk of MACE. But, how many patients with rheumatoid arthritis, at risk of MACE, are actually taking a statin?

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ACR Best

#ACR 2024 BEST Abstracts from Day 2

Jack Cush, MD

Here’s a collection of some of the best abstracts presented on day 2 of ACR 2024 as selected by the RheumNow faculty.

 

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ACR 2024 - Day 2 Report

Jack Cush, MD

Plenary sessions began the day, followed by thousands on the abstract floor. Here are a few of my favorite presentations from day 2 at ACR 2024.

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Phase 2 DAHLIA study in Sjogrens Anti-neonatal Fc receptor an “nipocalimab” w/remarkably encouraging results clinESSDAI significantly better at wk24, notably met QOL domains as well Finally getting good news in SjS! #ACR24 @RheumNow #ACRbest Abst#2527 https://t.co/e3uQmqJZ1o

Links:

Mike Putman EBRheum ( View Tweet)
📢 Late breaking #2002 ➡️In ICI-induced arthritis, patients (n=100) report worsened pain, fatigue, & physical function vs population norms. ➡️High disease activity worsens symptoms #acr24 @RheumNow @jhrheumatology

Caoilfhionn Connolly CaoilfhionnMD ( View Tweet)

If a mother has had TNFi during pregnancy, can a baby have a live oral rotavirus vaccine (usually at 2mo)? This claims data suggests no increase in diarrhoea Adds to similarly reassuring 🇨🇦prospective cohort data https://t.co/2Tz9zRhPjz Vaccinate away! #ACR24 ABST0806 @RheumNow https://t.co/66OIAR8W6l

Links:

David Liew drdavidliew ( View Tweet)
Abst#2413 SLE Cohort of > 2900 pts over 50 yrs - Prevalence of proteinuria at the time of SLE dx has not changed over the decades. Prevalence of proteinuria also did not change at 5 and 10 yrs after dx. Earlier use of HCQ has not led to a ⬇️in lupus nephritis. @RheumNow #ACRbest

TheDaoIndex KDAO2011 ( View Tweet)

Nice data from the OTIS Autoimmune Disease in Pregnancy Project re: certolizumab-exposed pregnancies: - spontaneous loss rate comparable to non-disease controls - no stillbirths - preterm similar to disease controls Plenty positive for CZP in pregnancy! #ACR24 ABST0805 @RheumNow https://t.co/XCRYsioxC0

Links:

David Liew drdavidliew ( View Tweet)
We know most preexisting autoimmune disease is very mangaeable when checkpoint inhibitors are needed. So great to see that, in the VA, autoimmune disease pts largely haven't missed out on potentially lifesaving cancer immunotherapy. Keep on reassuring! #ACR24 ABST1985 @RheumNow https://t.co/ApOACBLi4K

Links:

David Liew drdavidliew ( View Tweet)

Abst#1493 complete renal response (< 0.5 g/g w/< 10 mg/day pred); renal remission (UPCR < 0.3 g/g w/< 5 mg/day pred). 60 LN pts followed 3 yrs: 40% CRR & 19% RR. Pts not in CRR/RR had⬇️eGFR w/more decline in eGFR over time. No difference b/t CRR/ RR @rheumnow #ACRbest #ACR24

TheDaoIndex KDAO2011 ( View Tweet)

Instead of just JAKi, why don't we look at all our RA meds and MACE risk FAERS data & reporting odds ratios here: all the caveats of voluntary reporting, so don't put too much weight, but... prednisone. Don't forget pred is really not great for MACE! #ACR24 ABST1981 @RheumNow https://t.co/L9SlPZF2Jd

Links:

David Liew drdavidliew ( View Tweet)

Always looking for cancer/CV signals from JAKi in big observational datasets w extensive JAKi use nationwide 🇯🇵 claims data RA pts n=52k (JAKi n=4.3k) Cancer with JAKi vs TNFi: aHR 2.2 (esp lung, lymphoma) This is a problem. Watch these data. #ACR24 ABST1336 @RheumNow #ACRBest https://t.co/vsnT46De6T

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David Liew drdavidliew ( View Tweet)
ANA neg, but ENA pos should we care about that result? PPV 5.5% here (similar to 6% prev @EricFMorand: https://t.co/Hyaued3rw2) and how many really needed the serology? Anxiety? Surely pos ENA w neg ANA might be more hassle than help. So what to do?⬇️ #ACR24 ABST1930 @RheumNow https://t.co/rE7RmgOGey

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David Liew drdavidliew ( View Tweet)
Should you worry about giving TNFi to RA pts after a cancer diagnosis? Medicare data with colorectal, lung, prostate Ca: TNFi pts survival no worse (numerically better) than csDMARDs Cancer pts deserve good RA treatment! #ACR24 ABST0202 Suarez-Almazor @MDAndersonNews @RheumNow https://t.co/w58MNqRt1T

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David Liew drdavidliew ( View Tweet)
Upadacitinib in Behcet's disease - would be very much welcomed, and this open label 8 patient pilot from China is encouraging. We saw similar data for tofacitinib before @ARD_BMJ: https://t.co/YlAQVXpnTY JAKi (?generic) could be a fantastic option! #ACR24 ABST2515 @RheumNow https://t.co/65friNLUOK

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David Liew drdavidliew ( View Tweet)
Steroids in checkpoint inhibitor rheumatic irAEs need to be approached with caution. Persistent higher doses earlier on might dampen ICI response. @HSpecialSurgery ICI-IA (inflamm arthritis) cohort big diff in survival based on early steroid exposure #ACR24 ABST1989 @RheumNow https://t.co/3WAZ3ZLbFw

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David Liew drdavidliew ( View Tweet)
Rheumatic irAEs can get on the CAR-T bandwagon, too! CAR-T can invoke new rheumatological issues (not just cytokine release) - see @DrGomezPuerta's experience. Infrequent, but if CAR-T in general becomes common, yet another job for us to attend to... #ACR24 ABST2004 @RheumNow https://t.co/xBSlhUdkNr

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David Liew drdavidliew ( View Tweet)
Now that nipocalimab is approved for Sjogren's Disease, what about vaccination response whilst on this FcRn inhibitor (inherently lowers IgG)? Actually, not bad: takes a little longer to get there, but reassuring! (always fun to get to know a new med) #ACR24 ABST1988 @RheumNow https://t.co/IYqIGo5xVP

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David Liew drdavidliew ( View Tweet)
Here's a meta-analysis of MACE/malignancy in JAKi vs TNFi in observational cohort studies. All the epidemiological challenges here aside, it's a good reminder that with ORAL Surveillance it's *cardiovascular risk enriched pts* we're concerned about. #ACR24 ABST2264 @RheumNow https://t.co/vIXlrI3V2d

Links:

David Liew drdavidliew ( View Tweet)
We saw evidence for JAK use in GCA this conference... what about IL-1 inhibition? Double-blind RCT: Anakinra vs. PBO w/ similar GC taper in GCA pt NO difference in relapse rate at 26, 52 wks despite addition of Anakinra @RheumNow #ACR24 Abst1699 https://t.co/gUb0gGJjTG

Links:

Brian Jaros, MD Dr_Brian_MD ( View Tweet)
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