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Maintain Vigilance for CV Risk Postpartum in Autoimmune Diseases

Bella Mehta, MBBS, MS Nov 13, 2023

Pregnant women with autoimmune rheumatic diseases (ARDs) and antiphospholipid syndrome (APS) face significantly increased risks of cardiovascular events (CVEs). This increased risk is often attributed to ARDs, its medications or comorbidities associated with it.

GCs Major Driver of Depression in SLE Ab#1446 #ACR23 @RheumNow 1463 pts with SLE, prospective longitudinal study GC use: 49-57% of pts Prevalence of depression at any time: 89.8%, most of time 35%!! Risk factors: - Fibromyalgia OR 2.9 - GC OR 1.85

PRES in SLE A#1478 @RheumNow #ACR23 303 cases of Posterior Reversible Encephalopathy Syndrome in SLE - Mean age 28, 91% F - 42% HTN, HLD 15%, DM 10% - 83% lupus nephritis. 80% dsDNA, 41% Sm, 38% aPL - 78% seizures - 3% mortality - Transient in 45%, persistent in 19%, 8% sequelae

Vasculitis in SLE A#1443 @RheumNow #ACR23 804 SLE pts, 74% black, 9.5% h/o vasculitis 45% visceral vasculitis, 43% cutanous, 8% both Pts w vasculitis: younger age of SLE dx- 27 v 31y Risks: other SARD, renal dx, neuro dx, low compl Trend to higher mortality 21 to 14% (no signif)

Fate of ANA+/UCTD A#1449 #ACR23 @RheumNow 207 asymptomatic ANA+ or UCTD followed - <10% progress to SARD, 90% did not Progression to SLE (11 pt), Sjo (5), SSc (3), RA (1) Progressors to SLE: arthritis (91%), low compl (45%), alopecia (36%), ulcers (27%) - milder manifestations

SGLT2 inhibitors compared to DPP4i may be better at reducing risk for MACE & renal progression in patients with SLE/LN and diabetes. SGLT2i risk for MACE (HR 0.69, 95% CI 0.48-0.99), and renal progression (HR 0.71, 95% CI 0.51-0.98). abst# 1579 #ACRbest #ACR23 @rheumnow

#ACR23 Abstr#1512 Can we improve trial design of Bcell depletion in #SLE? Feasibility RCT of RTX in organ specific MSK showed: a) feasible to use ultrasound & clinical as endpoints, b) new tool LAMDA is responsive, c)potential worsening before later improvement with RTX @RheumNow https://t.co/YmbUOWVdWS

Do you discuss HPV vax & cervical CA screening w/SLE & RA pts? In this study, more women w/SLE discussed cervical CA screening w/their rheums(33.3% vs. 11.4% p<0.01) & more likely to have persistent abn paps on ffup Similar HPV vax status for both grps #ACR23 ABST1356 @RheumNow https://t.co/Vbu8hbZ1uh

#ACR23 Abstr#1509 SLR & Meta-Analysis of RCTs in lupus nephritis (N=16 studies): -CNI (VOC/TAC/CyA) alone (OR 1.4) or combined MMF (OR 2.1) was assoc with CR vs SOC (MMF/Cyclo) -Less GI AEs & cytopenia in CNI Assuring data esp when cost is a hurdle for VOC @RheumNow #ACRBest https://t.co/9ScakIdXBN

#ACR23 Abstr#1479 In N=66 patients with #SLE, 29% had high risk HPV infection. Associated with lupus disease duration. In 2nd screening ~1yr after, multiple infections occurred in 15%, about similar vs women with HIV. Call to promote HPV vaccination in SLE 💉 @RheumNow https://t.co/UGIrCwu32x

#ACR23 Abstr#1579 More data on the role of SGLT2-i in #SLE. Data from EHR using propensity match scoring showed the use of SGLT2-i vs DPP4-i (for nonSLE indication) was associated with reduced risk of MACE (HR:0.69)and poor renal outcomes inc. ESRD (HR:0.71) @RheumNow https://t.co/7k0o3m18AN

In their cohort, Dr. Jorge reports that SLE pts who used SGLT2i had⬇️risk of MACE(HR 0.69 [95% CI 0.48-0.99]) & renal progression(HR 0.71 [95% CI 0.51-0.98]) vs DPP4 use Risk of MACE also⬇️in LN subgrp 🧐💊A potential role of SGLT2i for SLE/LN? #ACR23 ABST1579 @RheumNow #ACRbest https://t.co/Dod8DqRvLo

#ACR23 @RheumNow SGLT2 inhibitors help CV & renal outcomes, but SLE pts excluded @AprilJorgeMD ComparedSGLT2 to DPP4 inhibs, real world observation emulation study in SLE pts with T2DM Lower incidence of MACE & renal progression Subgroup w LN - risk reduction 10.2 MACE/100 py https://t.co/JpJ0yWNQBe

Excellent start to Plenary II Should we borrow SGLT2i and DPP4i use from endocrine? SLE pts who initiated SGLT2 or DPP4: lower risk of MACE and renal progression @RheumNow #ACR23 Abs#1579 https://t.co/RsaWuetyft

Glucocorticoids-free zone in SLE? For over 70 years, glucocorticoids, (GC) have been a part of standard therapy in SLE. They are classically used to not only induce remission or treat an acute flare, but also as maintenance therapy. #ACR23 https://t.co/sfRhNj6OpZ https://t.co/k6VoG5lKO7

Glucocorticoids-free zone in SLE? | RheumNow

Patients with autoimmnue diseases have a high maternal and fetal complication rate! Abst 1003 #ACR23 @RheumNow https://t.co/pnvvBUN2JG

Pt w/ refractory SCLE, wants to get pregnant. Dr. Petri's approach is: counsel patient and review meds (e.g PPI's can induce SCLE). She also asks: Where's your hat and sunblock? Get HCQ blood levels b/f starting anifrolumab or belimumab #ACR23 @rheumnow #MeetExpert

Difficult SLE skin dse? Dr. Mosca reminds us to engage pts in the treatment process including adherence to preventive measures & lifestyle mods (sun protection, smoking) Other considerations: + antimalarials early use of newer tx? - Anifrolumab #ACR23 @RheumNow https://t.co/kz8YfcBB2d

When to use #belimumab and when to use #voclosporin? Dr. Dall'Era does the following: Belimumab: GFR<45, low proteinuria, extrarenal dz, pt factors Voclosporin: GFR>45 w/o sig chronicity, high level proteinuria (3+g/), pt preference for oral #ACR23 #MeetExpert @rheumnow https://t.co/0SXRBtChfk

"Get rid of partial response. Why would you want to see an oncologist who say I can get risk part of your cancer? Wouldn't you want to get rid of the whole cancer!" - Dr. M Petri on how we should view lupus nephritis #ACR23 @rheumnow #MeetExpert

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Maintain Vigilance for CV Risk Postpartum in Autoimmune Diseases

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