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Playing it Safe with RA? JAK vs. TNF Debate

Brian Jaros, MD

Reported safety signals, at odds with the efficacy of these medications, have left rheumatology clinicians in a difficult position when considering when during a patient’s treatment course and in which patients, specifically, JAKi should be used. Two abstracts from ACR convergence 2024 further contribute to our understanding of this potential risk profile.

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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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ACR24 Preview Podcast (11.15.2024)

Jack Cush, MD

ACR 2024 starts tomorrow. Here are a few previews of abstracts to be presented, along with my recommendations of sessions you don’t want to miss.

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Biosimilar Slow Growth in USA

Jack Cush, MD

A recent Forbes article, "Biosimilars Are Making Inroads In U.S., But It’s Still A Bumpy Ride", reviews the current state and reasons for slowish uptake of these significant cost-savings alternatives to biologic therapy in treating cancer and autoimmune disorders. The following are takeaway bullets from this informative article.

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Blue Collar Arthritis (10.25.2024)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal articles from this past week on RheumNow.com.

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Dot the "i", Cross the "t" (10.11.2024)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal articles from the past week on RheumNow.com. Today’s reports suggest where to look for help, especially with regard to pain.

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Playing it Safe with RA? JAK vs. TNF Debate The ORAL surveillance trial raised safety concerns that the janus kinase inhibitor (JAKi) tofacitinib was associated with an increased incidence of cancer and major adverse cardiovascular events (MACE), compared to tumor necrosis… https://t.co/sUSdRKRxEF https://t.co/XcjOqGlLVX
Dr. John Cush RheumNow ( View Tweet)
Biggest absence award at #ACR24 @ACRheum @RheumNow 🥇 Absence of discussion on 👇 #Oral #Surveillance Except for maybe Monitoring for mouth ulcers and cancers issues are not resolved but we are comfortable with ambiguity!

Janet Pope Janetbirdope ( View Tweet)

TNFis preventing cancer compared to placebo, and JAKi being neutral to placebo and maybe preventing haem cancers also. #ACR24 abstract 0989 was certainly provocative. I've shared my thoughts on @RheumNow https://t.co/yQFoUGifEN

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Richard Conway RichardPAConway ( 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

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David Liew drdavidliew ( 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

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Antoni Chan MD (Prof) synovialjoints ( 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

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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)
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)
#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

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Janet Pope Janetbirdope ( 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

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Mike Putman EBRheum ( View Tweet)
Give a listen to my @RheumNow interview w Josh Hsieh, a rising star at #ACR24, who is presenting his first (of many) research project as a high school sophomore! His work w @NamrataRheum explores what is known- & not yet known- for cancer survival in RA https://t.co/boqwpP9CUK https://t.co/UQ37pyvZT6

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Eric Dein ericdeinmd ( View Tweet)

Ab#474 #ACR24 Hsieh and @NamrataRheum Cancer Survival in RA Unable to do meta-analysis due to lack of data HR for lung cancer in RA 1.04 No clear evid of increased risk, but more data and studies needed Great research project by a high school student (!!) @RheumNow https://t.co/Sfrf2v2UO4

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Eric Dein ericdeinmd ( View Tweet)
Risk for atypical femoral fracture: 🚨Asian race - 4-6x higher risk Duration of use is greater risk than older age Higher risk when given for osteoporosis than cancer treatment - Compare: osteonecrosis of jaw more common with cancer Rx #ACR24 Review Course @RheumNow https://t.co/V8cD5QWNGp

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Eric Dein ericdeinmd ( View Tweet)
Biosimilar Slow Growth in USA A recent Forbes article, "Biosimilars Are Making Inroads In U.S., But It’s Still A Bumpy Ride", reviews the current state and reasons for slowish uptake of these significant cost-savings alternatives to biologic therapy in treating cancer and… https://t.co/yO3tUVk2jj https://t.co/ft6gqpnWMx
Dr. John Cush RheumNow ( View Tweet)
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