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The AURORA study with voclosporin has changed the way that Dr. Kalunian practices. He now uses lower doses of steroid, 40mg in induction with a faster taper in lupus nephritis. #RNL2023 @RheumNow https://t.co/8ss14Z5WXl
Dr. Rachel Tate uptoTate ( View Tweet)
Reassuring data by Dr. Laurent Arnaud on HCQ
- arrhythmia risk from HCQ similar to general population
@RheumNow #RNL2023 https://t.co/vMDg2SlbJQ
Robert B Chao, MD doctorRBC ( View Tweet)
A Pilot Trial of Anifrolumab in Discoid Lupus
A research report in JAMA Dermatology describes the use of the type 1 interferon receptor inhibitor anifrolumab in patients with chronic discoid lupus erythematosus (DLE).
https://t.co/MwruMhmvPq https://t.co/WnCvCZtq6z
Links:
Dr. John Cush RheumNow ( View Tweet)
BEAT LUPUS trial results showed that belimumab after RTX reduced dsDNA levels/flaring. Questions remain if this can be a successful combination in lupus nephritis. Dr. Kalunian #RNL2023 @RheumNow https://t.co/XeuybrWigf
Dr. Rachel Tate uptoTate ( View Tweet)
@RheumNow's review of new drug approvals during 2022 at #RNL2023 https://t.co/IgndlG6lOI
Dr. Rachel Tate uptoTate ( View Tweet)
How does HCQ work
@Lupusreference in #RNL2023
HCQ works by inhibition of Toll-like receptor (TLR) with affects on IFN
HCQ works as base to increase lysosomal pH and affect cellular function
@RheumNow https://t.co/RTEUF0cS0u
Eric Dein ericdeinmd ( View Tweet)
@Lupusreference in #RNL2023
HCQ and arrhythmia via QTc prolongation
At normal doses, same as general population
If on other QTc prolonging medications, a baseline EKG may be beneficial
@RheumNow https://t.co/cAN2vBNa1t
Eric Dein ericdeinmd ( View Tweet)
Any dose more than 1500 is associated with retinopathy ? So what to do. @Lupusreference #RNL2023 @RheumNow https://t.co/2zdjpcuvKa
Nouf Al hemmadi NoufAhmedAlham2 ( View Tweet)
Smoking and SLE
Smoking increases SLE activity
Smoking decreases HCQ efficacy
Skin response on HCQ down 50% in smokers 🚬
@Lupusreference #RNL2023 @RheumNow
Eric Dein ericdeinmd ( View Tweet)
TULIP trials in lupus, disease outcomes and others, by Richard Furie #RNL2023 @RheumNow https://t.co/uUQOxUIzJN
Nouf Al hemmadi NoufAhmedAlham2 ( View Tweet)
Dr. Furie: #RNL2023
Anifrolumab - anti type 1 IFN receptor- blocks all 5 IFN, 90% IFN gene signature decrease
Improved from prior older failed medication sifalimumab which only blocked IFNalpha- only 25% interferon gene signature
@RheumNow https://t.co/30oFRwwuTG
Eric Dein ericdeinmd ( View Tweet)
✅ Check my TAKE-HOME MESSAGES about #hydroxychloroquine & #Lupus for RheumNow Live 2023 #RNL2023
@RheumNow ⬇️ https://t.co/E2xdv3ODG6
Laurent ARNAUD Lupusreference ( View Tweet)
SRI Responders more likely able to reduce prednisone and far
Serological improvement
SF-36
Fatigue
by Richard Furie #RNL2023 @RheumNow https://t.co/ilsyOXw7nA
Nouf Al hemmadi NoufAhmedAlham2 ( View Tweet)
Compliance is always an issue, by Richard Furie #RNL2023 @RheumNow .
Plaquenil level were below target. Adherence is always something we need to work on. https://t.co/hMgL9kY0rZ
Nouf Al hemmadi NoufAhmedAlham2 ( View Tweet)
Dr. Ken Kalunian on Lupus nephritis
Don't forget about ACEi/ARB therapy for SLE pts with renal involvement
- can control BP
- reduce Urine proteinuria
- decrease risk of active renal disease
#RNL2023 @RheumNow https://t.co/hLBqjELqW2
Robert B Chao, MD doctorRBC ( View Tweet)
UPCR< 500 mg is the best predictor of a renal outcome in lupus nephritis. Multiple creatinine testing, Ken Kalunian #RNL2023 @RheumNow https://t.co/96PlXgqOfK
Nouf Al hemmadi NoufAhmedAlham2 ( View Tweet)
Belimumab in Active lupus nephritis , Ken Kalunian #RNL2023 @RheumNow https://t.co/VZkmK8Iny7
Nouf Al hemmadi NoufAhmedAlham2 ( View Tweet)
#RNL2023 Year in Review
@andreafava: urinary biomarkers in lupus nephritis
CD163, IL-16, CD206 decrease at 3 months.
Urinary biomarkers predict 1 year proteinuric response, esp in prolif LN.
Liquid biopsy as way to monitor instead of serial biopsies
@RheumNow https://t.co/baZt57Qjne
Eric Dein ericdeinmd ( View Tweet)
#RNL2023 Year in Review
HCQ levels in SLE
>500 ng/mL = 19x higher adherence
>750 ng/mL 67% lower odds of adherence
Higher levels with CKD
I use HCQ levels in all patients for monitoring at each visit
@RheumNow https://t.co/6yCefQdPU0
Eric Dein ericdeinmd ( View Tweet)
Should we be measuring HCQ levels?
- note HCQ doses should be reconsidered in pts with CKD stage >2 w/ 4 fold higher odds of HCQ levels
- adjust dose for pts with renal impairment
@RheumNow #RNL2023 https://t.co/JvaRJKJRPv
Robert B Chao, MD doctorRBC ( View Tweet)
