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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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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.
David Liew
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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
Janet Pope
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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
Dr. John Cush
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JAK-pot! How fast do DMARDs work?
Dr. Mike Putman interviews Dr. Kim Lauper about abstract 0501, How Fast Do JAK-inhibitors, TNF-inhibitors, Abatacept and IL-6 Inhibitors Act in Rheumatoid Arthritis? An International Collaboration of Registers of Rheumatoid Arthritis Patients… https://t.co/GO9EwyrVpV https://t.co/lELE5SJW5i
Dr. John Cush
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Continuing or Stopping Low Dose Glucocorticoids in GPA
Dr. Mike Putman reports about plenary session abstract 0774 (the TAPIR study) about how and when patients can stop steroids in GPA. #ACR24
https://t.co/OWqN0jmkc1 https://t.co/foOaVRtGiV
Richard Conway
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I've shared some thoughts on @RheumNow on methotrexate, tocilizumab, and baricitinib in PMR based on #ACR24 https://t.co/WXiW1nLN4k
Dr. John Cush
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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
Richard Conway
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Yang et al. Cranial vessel wall MRI in GCA. Quantitated with PEG score. PEG score ocular GCA>non-ocular GCA>non-GCA. Decreases with treatment. @RheumNow #ACR24 Abstr#2650 https://t.co/e26urOpb7V https://t.co/eekQbzmKYm
Eric Dein
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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
Richard Conway
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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
Antoni Chan MD (Prof)
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Study by Maria Dall'Era et al. compared voclosporin-based triple immunosuppressive therapy with high-dose GC in active lupus nephritis.
- Fewer adverse events in the voclosporin group, despite a higher incidence of specific issues like decreased GFR and hypertension.
- 25%… https://t.co/ToRu2rdErC https://t.co/uUXzNNuLDb
Mrinalini Dey
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How do you manage DMARDs when giving the recombinant #zoster #vaccine (#RZV)?
➡️75 pts with ARDs
💉2-week #MTX discontinuation after each dose of RZV
⏩Significant boost in immune response without difference in flare rates
Ab2612 #ACR24 @RheumNow https://t.co/o4iqj3e1Be
Eric Dein
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A#2650
MRI can show extent of vessel wall inflamm to guide severity of GCA
Brain & orbital MRI performed
Assessed 7 arteries bilaterally -> CAMRIS-GCA MRI score (0-10)
33 GCA (17 ocular), 41 not GCA
CAMRIS-GCA ass w/ ocular GCA, higher severity. Improved w Rx
@RheumNow #ACR24 https://t.co/19XCuZJXqF
sheila
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A higher number of axSpA pts enrolled in BE MOBILE 1&2 who were treated with BKZ achieved remission accdg to the OSI vs. ASDAS ID (40.5% vs 15.2%) at wk 16 until wk 52.
OSI a better measure of remission?
@RheumNow #ACR24 abs2362 https://t.co/GCHjXQi9S9
Richard Conway
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Medeiros-Ribeiro et al. Holding MTX for 2 weeks after recombinant zoster vaccine increases response with no increase in flare. @RheumNow #ACR24 Abstr#2612 https://t.co/NEop0XB5Ak https://t.co/P4S2qzbkTs
Mrinalini Dey
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SmPCs recommend interrupting immunosuppression (IS) in infection
What happens if you continue the drug?
Ab2611 found no difference in infection outcomes btwn temp interruption & continuation of IS in infection
Could continuation be a safe option in some pts?
#ACR24 @RheumNow https://t.co/14SN6a4Wm8
Dr. John Cush
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RIP to Glucocorticoids in GPA
For many years glucocorticoids were the mainstay of our treatment of granulomatosis with polyangiitis (GPA).
https://t.co/WqpO6ACqtu https://t.co/vb8qx3uHA0
Richard Conway
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Wang et al. Propensity score matched cohort study. 63,302 individuals. Colchicine associated lower risk of THR/TKR, HR 0.87. @RheumNow #ACR24 Abstr#2557 https://t.co/UUU3Tm67ML https://t.co/uKi0e8E7HV
Richard Conway
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Xia et al. Upadacitinib in refractory Behcets. Open label, 8 patients. Follow-up 4-14 months. Lower disease activity 2.5 vs 1.5. Lower pred, 11.9 vs 8.1. @RheumNow #ACR24 Abstr#2515 https://t.co/ZXsJkNRlTm https://t.co/S8LhpqZ8X3
