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ACR20 - Day 3 Report
Here are my highlights from day three, Sunday, of the ACR 2020 Convergence.
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SLR comparing the 4-dose ANCA #vasculitis (AAV) rituximab regimen (widely used in RCTs) to 2-dose #rheumatoidarthritis RTX regimen (common in clinical practice), to induce AAV remission, finds no difference in efficacy or safety.
Abs#2048 #ACR20 @RheumNow
https://t.co/WBaWN9d8vs
Mrinalini Dey DrMiniDey ( View Tweet)
Upadacitinib vs. Adalimumab vs. PBO in PsA Phase 3 RCT ⬇️MSK symptoms, PsO, function, pain, fatigue, rads progression in UPA *⃣UPA15 non-inferior to ADA for ACR20, UPA30 superior *⃣Similar VTE in all arms @RheumNow #ACR20 Abs#2026 https://t.co/OHzIjXKqAu
Robert B Chao, MD doctorRBC ( View Tweet)
Conditional recommendation to add bDMARD or tsDMARD in RA pts on maximally tolerated dose of MTX over adding HCQ+SSZ (triple therapy) per draft recommendation of new ACR RA treatment guidelines. #ACR20 @RheumNow @ElaineHusniMD https://t.co/MW0fOAeK09
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
Draft #ACR20 Rx Recs for RA: on max tolerated MTX - add bio or tsDMARD conditional recommendation over triple therapy (MTX, HCQ, SSZ). @RheumNow. https://t.co/s6fKEW8czc
Eric Dein ejdein1 ( View Tweet)
Draft #ACR20 Rx Recommendations for RA: MTX monotherapy conditionally rec over csDMARD dual or triple Rx, MTX+TNFi @RheumNow https://t.co/jyjRD5aadN
Eric Dein ejdein1 ( View Tweet)
Rituximab in AAV: how to dose?
Should we be giving:
- 'haem dosing': 375mg/m2 x4 doses
- 'RA dosing': 1000mg x2 doses
Systematic review says: no difference
Reassuring given the variation in practice in real life!
#ACR20 ABST2048 @RheumNow https://t.co/Jf4Ue6HRRL
David Liew drdavidliew ( View Tweet)
Dr Benard reports an SLR and meta-analysis of 27 studies comparing 2 rituximab regimes in AAV. 375mg x4 and 1000mg x2 equivalent. Remission in 91% vs 85%. Similar adverse event rates @rheumnow #ACR20 Abstr#2048 https://t.co/I0feVuZ8iy
Richard Conway RichardPAConway ( View Tweet)
Anakinra in #Stills disease - Double blind, placebo controlled RCT in Stills disease total 12pts, 6 placebo, 6 Rx grp. All pts reached ACR70 at week 2 without fever and sustained it at 12 weeks. 5/6 reached ACR90 @RheumNow
#ACR20 ABS#1633 #ACRbest https://t.co/9E4vm7WzhP
Bella Mehta bella_mehta ( View Tweet)
Wonder if you can predict which pts you can successfully taper off bDMARDs? Abst#1538 from Denmark showed that a neg IgM-RF (OR 0.26) & low Doppler serum score for 24 jts predicted successful discontinuation of bDMARDs at 2yr f/u in RA pts w/ DAS28-CRP<2.6. #ACR20 @RheumNow https://t.co/CbJTguxaoa
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
Abatacept in RA and ILD Patients: Dr Richard Conway (@RichardPAConway) #ACR20
https://t.co/e31VsnXFq5 https://t.co/sCrqLtXFFc
Links:
Dr. John Cush RheumNow ( View Tweet)
#FDA updates #ACR20 @rheumnow
labeling/warning changes:
belimumab- mortality removed
abatacept - angioedema added
baricitinib -hypersensitivity rxn added
gabapentin & pregabalin - respiratory depression added
k dao KDAO2011 ( View Tweet)
Dr Sanchez-Bilbao reports a study of 30 patients with LV GCA. Despite clinical remission with tocilizumab ongoing vascular inflammatory activity identified by PET in 70%. Significant implications for risk of tocilizumab withdrawal. @rheumnow #ACR20 Abstr#1921 https://t.co/f1isidSypn
Richard Conway RichardPAConway ( View Tweet)
Dr Winthrop reports on rates of influenza in RA in tofactinib clinical programme over 14-15 seasons. No significant differences in rates between tofa, ADA, MTX, and placebo. @rheumnow #ACR20 Abstr#L04 https://t.co/8RrG0I2Zwm
Richard Conway RichardPAConway ( View Tweet)
Dr Bergman reports on PROs in RCT of upadacitinib versus abatacept in bDMARD-IR RA patients. Greater improvement in PROs with upadacitinib especially in physical functioning, pain, and general health @rheumnow #ACR20 Abstr#1728 https://t.co/NWKrhYAfZn
Richard Conway RichardPAConway ( View Tweet)
Tocilizumab in GCA: what happens in the vessels?
Supporting excellent work @KQuinnRheum @petercgrayson earlier at #ACR20, LV-GCA data from Blanco/Gonzalez-Gay et al. Aorta still hot at 10.8±3.7 mo.
in LV-GCA on TCZ, clinical remission ≠ PET remission
#ACR20 ABST1921 @RheumNow https://t.co/ngBVL4rop8
David Liew drdavidliew ( View Tweet)
SELECT-CHOICE on UPA vs ABA in RA in NEJM Oct 2020. How about PROs? UPA wins in phys fxn, pain, general health over ABA. Abst#1728 @RheumNow #ACR20. ABA better if a safety concern, but this is more evid to go for UPA
Eric Dein ejdein1 ( View Tweet)
@rheumNow #ACR20 #ABSL02 registry data: Pts on biologics more likely to Shield at Home during COVID 19 as opposed to non-biologic or no systemic Rx at all. Such stringent mitigation tactics may contribute to the reported lower risk of adverse COVID-19 outcomes in biologics Pts
Olga Petryna DrPetryna ( View Tweet)
Retrosp study in France compared MRIs of 96 pts w/ SpA (65% w/ IBP) vs 104 w/o (25% w/ IBP):
- 65% of pts w/ SpA had bone marrow edema (BME) mainly in the iliac quad of intermed middle segment
- 20% w/o SpA had BME mainly in antero-middle quad. #Abst1535 #ACR2020 @RheumNow https://t.co/1ptGGUbUS4
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
How often do you perform NFC in suspected SSc patients? @RheumNow #ACR20
sheila RHEUMarampa ( View Tweet)