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SELECT-GCA suggests JAKis may be the new kid on the block
Clinicians treating giant cell arteritis (GCA) have long had to contend with a disappointingly limited selection of drugs from which to select. A new group of drugs is finally showing promise in the treatment of GCA.
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RIP to Glucocorticoids in GPA
For many years glucocorticoids were the mainstay of our treatment of granulomatosis with polyangiitis (GPA). The paradigm shifted with cyclophosphamide and then again with rituximab, and we used less steroids, but we still used lots. Avacopan teased the demise of steroids, but in the trial they, and now we, still use them. Glucocorticoids are our old trusty friend, our comfort blanket. But no more! Good riddance to the medication with the highest long-term adverse event burden that we use. Long-term glucocorticoids in GPA should now be a rarity. The reason for such exuberance is the TAPIR study presented by Dr. Peter Merkel at Saturday’s opening plenary session.
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New data to guide role of long-term, low dose GC in GPA
Active GPA s/p tx -> randomized to d/c pred within 1 mo or stay on 5mg daily
Fewer relapses on 5mg pred but w/qualifications:
👉 most flares = minor
👉 no difference in flares if RTX on board
@RheumNow #ACR24 Abst 0774 https://t.co/Jvc40QWLqM
Links:
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
Challener et al. TriNetX study. 32,000 patients. SGLT2i reduce need for gout visits (HR 0.94) ULT initiation (HR 0.69) and colchicine (HR 0.82). I worry about the discordant rates, ULT initiation much lower. @RheumNow #ACR24 Abstr#0848 https://t.co/VTKHMmDEKV https://t.co/C2opiDmBXx
Links:
Richard Conway RichardPAConway ( View Tweet)
🤵♂️Results from BACHELOR
➡️34 PMR pts
➡️18 BARI, 16 PBO
➡️Primary endpoint: CRP PMR-AS≤10 w/o oral GC rescue from W0 to 12
78% BARI pts reached primary endpoint vs 13% PBO
No new safety signals
BARI 4mg 12W, then 2mg 12W➡️36W low disease activity in PMR
Ab0858 #ACR24 @RheumNow
Mrinalini Dey DrMiniDey ( View Tweet)
How does #cardiovascular risk vary with #ACPA & #biologics in #RA?
⬆️BMI assoc with ⬆️MACE risk in ACPA+ pts
In ACPA- pts, BMI inversely assoc with MACE risk among pts on biologics
Further evidence to consider ACPA, BMI & MACE as part of RA management
Ab0870 #ACR24 @RheumNow https://t.co/UkkC146DWS
Mrinalini Dey DrMiniDey ( View Tweet)
Hamroun et al. Meta-analysis of glucocorticoids in pregnancy and breast-feeding. Increase pre-term birth with GCs, adjusted OR 2.24. Dose-dependent effect. Minimal breastmilk transfer. @RheumNow #ACR24 Abstr#0810 https://t.co/H0o9ElsHmc https://t.co/uciFP6UOhF
Links:
Richard Conway RichardPAConway ( View Tweet)
Cannabis in Pain:
CBD can help with nociceptive pain
THC better for neuropathic, centralized pain
Perhaps a role in helping decrease other medications like opiates
Clauw 16S18
#ACR24 @RheumNow https://t.co/kaQXrD4GAn
Links:
Eric Dein ericdeinmd ( View Tweet)
Abstract #0805
Data from OTIS Registry shows Certolizumab pegol (Cimzia) exposure during pregnancy was not associated with increased risk of major birth defects, structural defects, or adverse pregnancy outcomes. #ACR24 @RheumNow
Akhil Sood MD AkhilSoodMD ( View Tweet)
Is it safe to administer rotavirus vaccine to infants exposed in utero to TNFi?
Abstract#0806 shows no significant ↑ in the risk of diarrhea-related healthcare events among TNFi-exposed infants who received the vaccine compared to those who did not
@RheumNow #ACR24 https://t.co/HpTCgywE4H
Akhil Sood MD AkhilSoodMD ( View Tweet)
Langford et al. Abatacept NOT effective in GPA in ABROGATE RCT. 65 patients. Relapse/worsening in 62% vs 68%. No difference in any secondary end-point. @RheumNow #ACR24 Abstr#0823 https://t.co/yRFZ2diJFF https://t.co/LgXkPnDArE
Links:
Richard Conway RichardPAConway ( View Tweet)
A systematic review highlights the impact of glucocorticoids (GC) during pregnancy and lactation. Increased risks of preterm birth were noted with GC exposure, advocating for minimized doses and pregnancy-compatible treatments. Encouragingly, low levels of GC found in breast milk… https://t.co/7CnJUBrUDQ https://t.co/ZeGHFHNT13
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Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Data from the study by Dr. Aguilar et al showed that high dose NSAID use was not assoc'd with incident HTN in their cohort of early axSpA patients.
Shows important role of NSAIDs in #axSpA but still should be used judiciously
@RheumNow #ACR24 abs540
@rheum_cat @rheumarhyme https://t.co/LK5yFZynu4
sheila RHEUMarampa ( View Tweet)
Galloway et al report OCP/HRT use in RA is not associated with VTE in UK population based study. Increased risk by having RA, HR 1.52. Risk OCP HR 1.43, HRT HR 2.32 - neither statistical significant but very wide CI's! Hmm... @RheumNow #ACR24 Abstr#0134 https://t.co/CZNoRfYWe8 https://t.co/uC6jA9lcX9
Links:
Richard Conway RichardPAConway ( View Tweet)
The risk of discontinuing first line biologics was twice higher in non-radiographic female patients compared to males. Abstr#0572 @RheumNow #ACR24 https://t.co/1tQUhsbqUu
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Dhir et al. RCT of increasing folic acid from 5-10mg per week to 15-35mg per week if MTX intolerance. No benefit! Although significant placebo response and folic acid is relatively benign. @RheumNow #ACR24 Abstr#0525 https://t.co/D3yfV6a8t6 https://t.co/QpDa1alvMz
Links:
Richard Conway RichardPAConway ( View Tweet)
Data from the French DESIR cohort reveals no significant link between high-dose NSAID use and incident hypertension in patients with axial spondyloarthritis. Two thirds were high dose NSAID users at baseline. Incident hypertension occurred in 11% individuals during follow-up.… https://t.co/EAICDwzxNT
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Serrano-Combarro et al. Abatacept in RA-ILD. 343 patients. In 23.3% ILD progressed on abatacept. Is that good or bad? We need comparative studies! @RheumNow #ACR24 Abstr#0475 https://t.co/nUEDdjGguA https://t.co/sXEF72MafK
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Richard Conway RichardPAConway ( View Tweet)
Are you pts using cannabis?
In Canada - 20% reported using w/in past 2 years
Use for pain, sleep, anxiety
78% noted efficacy
Compare to another study said 57% stopped due to inefficacy, 28% AEs - very diff result
70% did not tell their doc
16S18 @BharatKumarMD
#ACR24 @RheumNow https://t.co/6NAECW5MJK
Links:
Eric Dein ericdeinmd ( View Tweet)
Serrano-Combarro et al. Baricitinib in RA-ILD . 72 patient case series. PFTs in picture. HRCT stable/improved in 72% over 24 months. Dyspnoea stable/improved in 90%. @RheumNow #ACR24 Abstr#0476 https://t.co/aVI2kRZkMN https://t.co/4l5GKsFKtm
Links:
Richard Conway RichardPAConway ( View Tweet)
