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Frideres et al. Target trial emulation in RA-ILD. Primar outcome death or respiratory hospitialization. Abatacept (aHR 0.90), tocizilumab (aHR 0.93), tofacitinib (aHR 0.69) vs rituximab. @RheumNow #ACR24 Abstr#1713 https://t.co/fbE8xAnzQ2 https://t.co/uwzH8oAyAT
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Richard Conway RichardPAConway ( View Tweet)
A#1694
To get one or two lungs for lung transplant? 🫁
Autoimmune related ILD transplant outcomes?
145 single (SLT), 461 double (DLT)
Similar 1 yr mortality - HR SLT 1.19 unadjusted, 1.49 adj - not statistically significance
@RheumNow #ACR24 https://t.co/uo8WbrNFAm
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Eric Dein ericdeinmd ( View Tweet)
A retrospective analysis by Dr. ERayens et al showed that RA pts >/=50y given 2 RZV doses were less likely to develop HZ vs. unvaxxed grp
Incidence of PHN was also lower in the vaccinated group (0.2py vs.1.9py)
RZV is effective in preventing HZ & PhN
@Rheumnow #ACR25 abs0977 https://t.co/JhYBYnLmhl
sheila RHEUMarampa ( View Tweet)
2023 @ACRheum guidance recommends #MediterraneanDiet in RA
What are barriers/facilitators to following the diet?
Many pts are willing to try but don't follow it
Barriers➡️ food insecurity & aversions
Many are unaware
Do you talk to your pts about diet?
Ab1673 #ACR24 @RheumNow
Mrinalini Dey DrMiniDey ( View Tweet)
RA-ILD:
💡Lifetime prevalence seems low but ~40% can have subclincal.
💡Screen early in symptomatic pts.
💡RA disease control decreases ILD progression and mortality.
💡RA-ILD UIP pattern seems to respond to immunosuppression.
#ACR24 @RheumNow https://t.co/q3iACMeYVU
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Adela Castro AdelaCastro222 ( View Tweet)
Subgroup data from SELECT GCA, overall reinforces overall message
I was curious to see pts previously treated with TCZ; wonder if that selects for refractory phenotype - seems not to be the case
Take home: encouraging data, no subgroup issues
#ACR24 @RheumNow Abstr#1695 https://t.co/5iCLE6T4u3
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Mike Putman EBRheum ( View Tweet)
This will change my practice!
#RCT #MMF + #MTX
superior to
#Cyclophosphamide then #Azathioprine
In
#Tayakasu’s #arteritis N=150
RCT ~1g BID #mycophenolate + 15mg/wk #Methotrexate
Vs #cyclo ➡️100mg #azathioprine
All got #glucocorticoids
#ACR24 @RheumNow @ACRheum #1696 https://t.co/OpRep1vsmx
Janet Pope Janetbirdope ( View Tweet)
Very neat simulated model of GC regimens in AAV pt on fixed RTX by @zach_wallace_md and co
Over 5 years:
- No difference in relapse btwn standard GC vs. minimal GC + avacopan
- Higher DMII rates in standard group
Adds to trial + real world data
@RheumNow #ACR24 Abst 1598
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
Alright help me out here; this is pretty implausible, right?
Why would be pts be 11% more adherent to UPA? What's the bio-plausibility here? UPA 10% better than other JAKs?
Could do a network meta analysis; betting this doens't replicate
#ACR24 @RheumNow Abstr#1362 https://t.co/vpPq3vu9Wf
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Mike Putman EBRheum ( View Tweet)
#Rheumatoid #arthritis is an independent risk factor for death in nonmetastatic clear cell renal ca !
👇N=32K, 802 w RA also
Caveats
immunotherapy Offered = in RA
Cancer specific mortality not affected
By #RA
Frailty & RA affected outcomes
#ACR24 @RheumNow @ACRheum #1327 https://t.co/rAQ57BPA19
Janet Pope Janetbirdope ( View Tweet)
In this large 🇦🇺 RA cohort, median time on treatment for upadacitinib was lot higher than other JAKi
(28mo vs 17mo)
Why?
Patient selection, or a real difference between JAKi?
Would really like more comparative effectiveness data between JAKi
#ACR24 OPAL group ABST1370 @RheumNow https://t.co/OU2ayzqIc8
David Liew drdavidliew ( View Tweet)
Spicy network SRMA, 123pts w/JAK-TNF-PLBO
TNF >> JAK w/respect to malignancy (expected) & better than PLBO (spicy!)
JAK > PLBO for heme cancers (makes sense); no significant (but slight trend) toward PLBO > JAK for all cancer
The debate continues
#ACR24 @RheumNow Abstr#0989 https://t.co/tBnb02gyzF
Mike Putman EBRheum ( View Tweet)
Which RA patients are at increased risk of JAKi adverse events? Does disease activity matter?
in the upadacitinib ph3 trials, high disease activity pts had more:
serious infections
HZ
MACE
VTE
Active RA is a massive contributor to many AEs in JAKi pts
#ACR24 ABST1393 @RheumNow https://t.co/DlFf9Sfbja
David Liew drdavidliew ( View Tweet)
Zhang @jeffsparks et al. Even more evidence that MTX does not cause ILD, and in fact prevents ILD, in RA, OR 0.48 in meta-analysis. @RheumNow #ACR24 Abstr#1384 https://t.co/YvQnmmvNjF https://t.co/crYUwHahDb
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Richard Conway RichardPAConway ( View Tweet)
The idea of patient-initiated follow-up for RA is enticing:
patient & physician time is already stretched
minimize unnecessary visits/improve access
but what actually needs to go into the design, to make it safe/workable?
A: plenty.
🇨🇦 pilot underway
#ACR24 ABST1041 @RheumNow https://t.co/03u4bhnQ0v
David Liew drdavidliew ( View Tweet)
STAR trial of GC w/d in RA LDA
SEMIRA of GC w/d controlled RA on Toci
Very slight disease activity increase, but higher flares
No symptomatic adrenal insufficiency, but data of abnormal ACTH stim
No good evidence of steroid w/d symptoms
Beth Wallace
@RheumNow #ACR24 https://t.co/j6UPWlVNIu
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Eric Dein ericdeinmd ( View Tweet)
Serrano-Combarro et al. Case series of upadacitinib in RA-ILD. 18 patients. Report stable/improved dyspnoea and HRCT over 12 months. PFTs shown, relatively stable @RheumNow #ACR24 Abstr#1372 https://t.co/yncy0lPq60 https://t.co/mrDMtEDwUt
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Richard Conway RichardPAConway ( View Tweet)
Great table re:side effects of even low dose steroids in RA
Likely generalizes to other diseases ie PMR, SLE
P in prednisone stands for poison!
#ACR24 @RheumNow https://t.co/0opDEtzm9E
Mike Putman EBRheum ( View Tweet)
Are biosimilar multi-switches an issue?
real world data: DANBIO 🇩🇰
biosimilar to biosimilar switch
having already had a switch prior ('previous ADAo') did not increase cessation
The risk of biosimilar switching on immunogenicity is greatly overstated
#ACR24 ABST1000 @RheumNow https://t.co/1yAfZrrNd0
David Liew drdavidliew ( View Tweet)
Sukumaran et al. Does does of IA steroid matter in knee injection? RCT 30 patients. Triamcinolone. 6-week WOMAC decrease 6% in 10mg, 10% in 20mg , 29% in 40mg @RheumNow #ACR24 Abstr#1186 https://t.co/WUYiEP5dSo
Richard Conway RichardPAConway ( View Tweet)
