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ACR 2024 - Day 3 Report
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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JAKs and Other Drugs in PMR
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.
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LEVI-04 a novel neurotropin3-i showed:
-significant analgesia across all measures
-improvement in functional measures and PGA for all doses in a Ph2 RCT
- well tolerated
Hopefully will prove to be a therapeutic option for knee #osteoarthritis in future
@RheumNow #ACR24 absL15 https://t.co/kWsyyyGxyU
sheila RHEUMarampa ( View Tweet)
PHOENYCS GO, RCT of dapirplizumab, novel CD40Li in SLE
Met primary endpoint (NNT~6 for BICLA) & numerical improvements in many other endpts
1 MI & 1 death from infection over 213 pts
Encouraging for sure! Second phase 3 being launched
#ACR24 @RheumNow Abstr#L16 #ACRbest https://t.co/QwDMKjhFvb
Links:
Mike Putman EBRheum ( View Tweet)
#MDA5 #dermatomyositis assoc #ILD
May do better w
#tofacitinib vs #CNI in 515 pts
Too bad they didn’t do a pragmatic RCT as we do t know the reasons for prescribing each #Rx
But impressive survival w #tofa
#ACR24 @ACRheum @RheumNow abst1736 https://t.co/HLJknSYcNJ
Janet Pope Janetbirdope ( View Tweet)
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
Links:
David Liew drdavidliew ( View Tweet)
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
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
Richard Conway RichardPAConway ( View Tweet)
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
Dr. John Cush RheumNow ( View Tweet)
A#2651
Vasculitis w VEXAS
81 men, median age 67 - 27% had evid of vasculitis, variable size vessel
22% SVV- 17/18 cutaneous, one peritubular capillaritis on renal bx
2.5% MVV (2 cutan), LVV (2 carotid thickening, 1 had +TA bx), ANCA+
@RheumNow #ACR24 https://t.co/puablIBLCP
Eric Dein ericdeinmd ( View Tweet)
What factors are assoc with uptake of newer meds in RA?
➡️Incr use of b/tsDMARDs over 10yrs
➡️Use of newer drugs lower in older ppl, socioeconomic deprived & Asian/Black ppl
Could this indicate disparities in access to meds? How can we best address this?
Ab2608 #ACR24 @RheumNow
Mrinalini Dey DrMiniDey ( View Tweet)
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
Eric Dein ericdeinmd ( View Tweet)
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
Links:
Richard Conway RichardPAConway ( View Tweet)
A#2648
PET for GCA
Delayed imaging at 180 min improve dx performance for pts on GCs
Optimal PET w/in 3 days of GC, most patients unable to do w/in that window
Delay has sensitivity 92% even on prednisone - may be good tool for pts unable to get early PET/CT
#ACR24 @RheumNow https://t.co/kxpNfRqkGN
Links:
Eric Dein ericdeinmd ( View Tweet)
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
Links:
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
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
Mrinalini Dey DrMiniDey ( View Tweet)
Among axSpA patients enrolled in the BE MOBILE 1&2, those who received Bimekizumab achieved ASAS40 response earlier vs PBO
Improvements in spinal pain and physical function were significantly reported as early as wk 1 in those who received BKZ vs PBO
@RheumNow #ACR24 abs2363 https://t.co/JmcQdURTY4
Links:
sheila RHEUMarampa ( View Tweet)
A#2582 McInnes
Sonelokimab - IL17A,F nanobody
Prior P2 in PsO, HS
ARGO: P2 W24 RCT
Significant improv in ACR response
High PASI90/100 data
Up to 60% achieved MDA by W24
Improved PsAID domains (PRO)
Safety no IBD, MACE, depr. 2% oral candida
IZAR-1,2 - P3 ongoing
#ACR24 @RheumNow https://t.co/O4fEhTC8jK
Links:
Eric Dein ericdeinmd ( View Tweet)
SEC demonstrated high retention rates after 5 years in pts with PsA and r-axSpA in this real-world study.
Reasons for stopping SEC:
lack of efficacy
pt decision
lost to ffup
AEs
Reassuring data on SECs position in the treatment of PsA/AS.
@Rheumnow #ACR24 abs2344 https://t.co/zECEsheQIi
sheila RHEUMarampa ( View Tweet)
A#2584 Mease
Zasocitinib TAK-279 - potent, selective TYK2i
P2b, 12w PsA RCT
15/30 mg - similar response, better than PBO for ACR20/50/70, MDA, DAPSA, PASDAS
29% MDA v 13% PBO
Safety no signal for MACE, cancer, serious ifn, death. Mild acne signal noted
@RheumNow #ACR24 https://t.co/1eqD9R5fLe
Links:
Eric Dein ericdeinmd ( View Tweet)
