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Addressing CV Risk in RA: Are we doing enough?

Mrinalini Dey, MD

ORAL surveillance was a post-authorisation safety study of tofacitinib 5mg and 10mg versus TNF inhibitors, focusing on rates of adverse events, including MACE. A higher incidence of MACE was observed with the use of tofacitinib. Statins are recommended in patients with a history of atherosclerotic disease or 10 year predicted risk of MACE. But, how many patients with rheumatoid arthritis, at risk of MACE, are actually taking a statin?

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ACR Best

#ACR 2024 BEST Abstracts from Day 2

Jack Cush, MD

Here’s a collection of some of the best abstracts presented on day 2 of ACR 2024 as selected by the RheumNow faculty.

 

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Conv3.jpg

ACR 2024 - Day 2 Report

Jack Cush, MD

Plenary sessions began the day, followed by thousands on the abstract floor. Here are a few of my favorite presentations from day 2 at ACR 2024.

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Instead of just JAKi, why don't we look at all our RA meds and MACE risk FAERS data & reporting odds ratios here: all the caveats of voluntary reporting, so don't put too much weight, but... prednisone. Don't forget pred is really not great for MACE! #ACR24 ABST1981 @RheumNow https://t.co/L9SlPZF2Jd

Links:

David Liew drdavidliew ( View Tweet)

Always looking for cancer/CV signals from JAKi in big observational datasets w extensive JAKi use nationwide 🇯🇵 claims data RA pts n=52k (JAKi n=4.3k) Cancer with JAKi vs TNFi: aHR 2.2 (esp lung, lymphoma) This is a problem. Watch these data. #ACR24 ABST1336 @RheumNow #ACRBest https://t.co/vsnT46De6T

Links:

David Liew drdavidliew ( View Tweet)
ANA neg, but ENA pos should we care about that result? PPV 5.5% here (similar to 6% prev @EricFMorand: https://t.co/Hyaued3rw2) and how many really needed the serology? Anxiety? Surely pos ENA w neg ANA might be more hassle than help. So what to do?⬇️ #ACR24 ABST1930 @RheumNow https://t.co/rE7RmgOGey

Links:

David Liew drdavidliew ( View Tweet)
Should you worry about giving TNFi to RA pts after a cancer diagnosis? Medicare data with colorectal, lung, prostate Ca: TNFi pts survival no worse (numerically better) than csDMARDs Cancer pts deserve good RA treatment! #ACR24 ABST0202 Suarez-Almazor @MDAndersonNews @RheumNow https://t.co/w58MNqRt1T

Links:

David Liew drdavidliew ( View Tweet)
Upadacitinib in Behcet's disease - would be very much welcomed, and this open label 8 patient pilot from China is encouraging. We saw similar data for tofacitinib before @ARD_BMJ: https://t.co/YlAQVXpnTY JAKi (?generic) could be a fantastic option! #ACR24 ABST2515 @RheumNow https://t.co/65friNLUOK

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David Liew drdavidliew ( View Tweet)
Steroids in checkpoint inhibitor rheumatic irAEs need to be approached with caution. Persistent higher doses earlier on might dampen ICI response. @HSpecialSurgery ICI-IA (inflamm arthritis) cohort big diff in survival based on early steroid exposure #ACR24 ABST1989 @RheumNow https://t.co/3WAZ3ZLbFw

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David Liew drdavidliew ( View Tweet)
Rheumatic irAEs can get on the CAR-T bandwagon, too! CAR-T can invoke new rheumatological issues (not just cytokine release) - see @DrGomezPuerta's experience. Infrequent, but if CAR-T in general becomes common, yet another job for us to attend to... #ACR24 ABST2004 @RheumNow https://t.co/xBSlhUdkNr

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David Liew drdavidliew ( View Tweet)
Now that nipocalimab is approved for Sjogren's Disease, what about vaccination response whilst on this FcRn inhibitor (inherently lowers IgG)? Actually, not bad: takes a little longer to get there, but reassuring! (always fun to get to know a new med) #ACR24 ABST1988 @RheumNow https://t.co/IYqIGo5xVP

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David Liew drdavidliew ( View Tweet)
Here's a meta-analysis of MACE/malignancy in JAKi vs TNFi in observational cohort studies. All the epidemiological challenges here aside, it's a good reminder that with ORAL Surveillance it's *cardiovascular risk enriched pts* we're concerned about. #ACR24 ABST2264 @RheumNow https://t.co/vIXlrI3V2d

Links:

David Liew drdavidliew ( View Tweet)
We saw evidence for JAK use in GCA this conference... what about IL-1 inhibition? Double-blind RCT: Anakinra vs. PBO w/ similar GC taper in GCA pt NO difference in relapse rate at 26, 52 wks despite addition of Anakinra @RheumNow #ACR24 Abst1699 https://t.co/gUb0gGJjTG

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Brian Jaros, MD Dr_Brian_MD ( View Tweet)

Super helpful results from COVER study, holding JAK or IL17 for COVID boosters Antibody titers went up regardless of holding Holding caused flares (14-25% increase!) Pretty clear message; continue JAK / IL17 #ACR24 @RheumNow Abstr#1718 #ACRbest https://t.co/Mf89dWrRWz

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Mike Putman EBRheum ( View Tweet)
Would be helpful for us (and pts) to better understand rimmunotherapy agent specific risk on subsequent GCA/PMR AFTRER propensity matching of >7k pt on combo nivolumab/ipilimumab compared to pembrolizumab: - PMR RR 3.8x N/I vs. P - no diff in GCA risk @RheumNow #ACR24 https://t.co/IF4Gh7Cumd

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Brian Jaros, MD Dr_Brian_MD ( View Tweet)
Phase 2 RCT of MK2 inhibitor did not show clinical efficacy at week 12 in active AS pts compared to PBO. There are still unmet needs for additional therapeutics in pts with AS that not respond to current therapies. Abst#1760 #ACR24 @RheumNow https://t.co/cXv8HYr0Xr

Links:

Adela Castro AdelaCastro222 ( View Tweet)
Comparison of infection risk across b/tsDMARDs in IA in real-world study Treatment with ➡️Rituximab ➡️JAKi ➡️Anti-IL6 assoc with ⬆️⬆️ risk of severe infection compared to TNFi A reminder to consider comorbidities & infection risk in selecting b/tsDMARDs Ab1716 #ACR24 @RheumNow

Mrinalini Dey DrMiniDey ( View Tweet)

RCTs are the gold standard in drug research, but rising placebo (PBO) response rates with global recruitment could distort treatment effects. Limited access to care in less affluent countries may be a factor. #ACR24 @RheumNow ABST#1746 https://t.co/fVeNcw5qwO

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Jiha Lee JihaRheum ( View Tweet)
In this systematic review & metaanalyis by Dr. RFarhat et al, tacrolimus whole blood levels decrease in the 1st & 2nd trimesters then increase back to pre-pregnancy levels postpartum. Needs further studies to guide dose adjustment. @RheumNow #ACR24 abs1535 https://t.co/5MovzPJoFc

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sheila RHEUMarampa ( View Tweet)
Dr. BDinneen et al reported predictors that can help screen axSpA pts w/o traditional CV RFs for carotid doppler utz: - shorter dse duration - no family hx of IHD - HLAB27+ - ⬆️ dBP, WHratio, ferritin, TC, LDL and TC:HDL ratio Small size, more data reqd @RheumNow #ACR24 abs1440 https://t.co/3pZxFmutJz

Links:

sheila RHEUMarampa ( View Tweet)
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