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ACR 2022 Appraisal, Praise & Critique (11.18.2022)
It was great to be back at an ACR annual meeting, this one in Philadelphia - Philly was great. A walking town, rich in culture, history and good places to meet and mingle.
I loved the city, but not the convention center (not easy to navigate).
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Dual target blockade may be better than one in SLE
Inhibition of B-cell Activating Factor (BAFF) has revolutionised the treatment of patients with systemic lupus erythematosus. However, outcomes of therapies within the same class (i.e. BAFF-inhibitor) when evaluated in randomised controlled trials have been inconsistent.
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Think Before You Order: Choose Wisely
Early in medical training, we are taught diagnoses are made 90% of the time based only on the history and physical exam of the patient; laboratory tests play a minor role. When ordered, tests are used as evidence to support the diagnosis already made by the physician.
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Is exercise the missing medicine in lupus?
For lupus, sedentary lifestyle may be a driving force of disease activity. Today, the final day of ACR, Sarah Patterson, MD from UCSF will present
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Exciting Data for SLE: Plenaries from #ACR22
Dr. Michael Putman ( @EBRheum ) shares SLE updates shared at #ACR22.
https://t.co/e6tCwLdHMS https://t.co/u7yoE4T9Zs
Links:
Dr. John Cush RheumNow ( View Tweet)
Dual target blockade may be better than one in SLE
Dr. Yusof ( @Yuz6Yusof) discusses abstracts #L07 and #1001 presented at #ACR22.
https://t.co/0SzQAorzZy https://t.co/fZ6CpFNSWI
Links:
Dr. John Cush RheumNow ( View Tweet)
Ab1674 #ACR22 HCQ in pregnancy is SAFE and Standard of Care!
In Utero Exposure to HCQ does NOT ass w/ ocular toxicity: OCTs 5 yrs after birth đź‘€
PATCH study of HCQ to reduce CHB in pregnancy
18% CHB (historical) -> 7% treated risk
OCT: retinal thickness nml at 5 yrs
@RheumNow
Eric Dein ericdeinmd ( View Tweet)
Askanase et al. Phase 2 RCT Cenerimod (S1P modulator) in SLE. Primary endpoint not met. Some suggestion of efficacy at highest 4mg dose. But if its already like this in a phase 2, I doubt a phase 3 will bring better results @RheumNow #ACR22 Abstr#1656 https://t.co/p4fcKW3cYD https://t.co/ha8xqeW6Xk
Richard Conway RichardPAConway ( View Tweet)
This single ctr retro cohort study by Dr ZKazmi showed ⬇️HPV vax rates & ⬆️HPV infxn rates
🔅In HPV+ pts, risk of persistent HPV infxn was similar among ♀️ aged 21-26y & 27-45y (p>0.05)
Is it time for updated cervical ca screening guidelines for #lupus?
#ACR22 @RheumNow ABST#1671 https://t.co/7Nh62EYc6Y
sheila RHEUMarampa ( View Tweet)
Ab1671 #ACR22 Cervical Cancer screening in SLE
106 SLE patients, mean age 40. Only 3.7% w HPV vax!
24% abnml PAP, 30% HPV infection
HPV highest in 21-26 yo (83%) vs 27-45 (35%)
ASCUS 50% HPV+, 1 pt squamous cell ca
Recs: HPV Vaxđź’‰, test HPV as high positivity
@RheumNow @KDAO2011 https://t.co/nHlvGVVm40
Eric Dein ericdeinmd ( View Tweet)
Rossato et al. Women in highest tertile ultra-processed food intake 50% more likely to develop SLE than those in lowest tertile. Exacerbated by high BMI. @RheumNow #ACR22 Abstr#1634 https://t.co/T4Bx59VJPX https://t.co/oWaj9QbzgY
Richard Conway RichardPAConway ( View Tweet)
Pooled data from AURORA 1 and 2 show that Voclosporin maintained reductions in UPCR vs. control over the 3-yr treatment period in pts with #lupus nephritis
#ACR22 @RheumNow ABST#1653 https://t.co/C4n6Yb8bdC
sheila RHEUMarampa ( View Tweet)
Nestor et al. HCQ <5mg/kg day assoc increased hospitalisation for SLE flare. aOR 4.41 (95% CI 1.50-12.98) @RheumNow #ACR22 Abstr#1654 https://t.co/I4bTu2DWaR https://t.co/jpOwHUTenk
Richard Conway RichardPAConway ( View Tweet)
Are we giving enough HCQ?🤔
Findings from the study of Dr J Nestor show that ⬇️dose HCQ (</= 5mkd or <400mg/day) is associated w/ ⬆️hospitalizations for #lupus (adj. OR 4.41; 3.48)
#ACR22 @RheumNow ABST#1654 @rheumarhyme #ACRBest https://t.co/XCoZgbdOim
sheila RHEUMarampa ( View Tweet)
What’s new w #classification for #APS? You don’t have to have 2 positive tests disseminated in time. BUT remember the the labs for anticardiolipin are shockingly variable btwn centres. @RheumNow #ACR22 https://t.co/NTqQ6h7fws
Janet Pope Janetbirdope ( View Tweet)
Chen et al. Appendicitis associated increased risk incident SLE in population-based case-control study from Taiwan. HR 2.04 @RheumNow #ACR22 Abstr#1750 https://t.co/L9dTpMdHNP https://t.co/mEHeL6JnuE
Richard Conway RichardPAConway ( View Tweet)
#ACR2022 L07: Telitacicept - anti-BlyS and APRIL in SLE
335 pts P3 52 wk study TEL 160 mg SQ q7d vs PBO
83% SRI4 response in TEL vs 38% PBO (p<0.001)
As early as w4, sustained to w52
Most common AEs: URIs, decr IgG/IgM, injxn site rxn, UTI
@RheumNow #ACRBest https://t.co/UpEwEaonDO
Eric Dein ericdeinmd ( View Tweet)
A Novel Treatment Response Measurement Tool for Lupus
Dr. Dao discusses abstract 2054 with Dr. Morand at the #ACR22 Convergence. Abstract 2054: Towards a Novel Clinician-Reported Outcome Measure for SLE – Outcomes of an International Consensus Process.
https://t.co/iqqyI953Vz https://t.co/taUjTHsrJ2
Links:
Dr. John Cush RheumNow ( View Tweet)
Even young SLE patients are still at high risk of severe COVID:
- in general pop, age is key factor
- in SLE, risk is high across age groups (maybe due to both meds & disease)
- vaccination makes a big diff but SLE pts still at high risk
ABST1591 @CCalabreseDO #ACR22 @RheumNow https://t.co/ra1F79ITn3
David Liew drdavidliew ( View Tweet)
Wu et al Phase 3 RCT of Telitacicept (targets BlyS and APRIL) in SLE. Primary endpoint met at week 52! SRI(4) 67% vs 33% or 83% vs 38% (P<0.001 for both) depending on how you want to slice it. @RheumNow #ACR22 Abstr#L07 https://t.co/nnKr4AU8Jk https://t.co/9BVF6OljFQ
Richard Conway RichardPAConway ( View Tweet)
