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Survival and Mortality in RA: time to move away from “one-size fits all”?
Patients with RA are known to have a higher mortality risk than the general population.
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Avoid Abatacept in RA patients with a history of cancer?
The management of RA patients with a history of cancer continues to be an area of concern. General recommendations are to treat patients with a history of solid organ cancer as no different to any other RA patient. Recently, the ORAL-Surveillance study demonstrated evidence of a greater risk of cancer with tofacitinib than with TNF inhibitors. In this setting, two posters both reassure and raise a new cause for concern.
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Difficult to treat #rheumatoidarthritis - phenotypes need to be defined and order of Rx may be v Impt. Well, it is really difficult @RheumNow #ACR22 session 12S127 https://t.co/x3bkUP590A
Janet Pope Janetbirdope ( View Tweet)
BIOBADASAR study of cancer risk in RA patients with prev cancer treated with b/tsDMARD. No increased risk, but yet again abatacept numbers are making me slightly nervous! @rheumnow #ACR22 Abstr#0267 https://t.co/H8gYm9STT3 https://t.co/sEIS6Ljwao
Richard Conway RichardPAConway ( View Tweet)
Kunishita et al Abatacept in those with RA and prev cancer (or not). Equally effective. No significant difference in 5-year malignancy but those curves look like they are diverging to me! @rheumnow #ACR22 Abstr#0255 https://t.co/1E2SXMGbqD https://t.co/gTvOOnuzo0
Richard Conway RichardPAConway ( View Tweet)
What do you do if a person with #rheumatoidarthritis was great on 1st JAKi. It was 1st line advanced Rx @RheumNow #ACR22
Janet Pope Janetbirdope ( View Tweet)
@ericdeinmd is moderating a great session, difficult to treat RA at #ACR22 right now! #rheumpix @RheumNow https://t.co/R5yg3eme6v
Dr. Rachel Tate uptoTate ( View Tweet)
OPAL data is a gem! Large Australian data studying JAKi use in #rheumatoidarthritis N=5900 Switching JAKi~JAKi-common. As in TNFi 1st line Rx had longer retention & better efficacy than 2nd & subsequent. Median 1st advanced Rx - same in all JAKs 34 MOA @RheumNow #ACR22 abst0274 https://t.co/FQU4AKXwe9
Janet Pope Janetbirdope ( View Tweet)
OPAL dataset 🇦🇺: 55000+ RA pts, 1/10 first line JAKi. Persistence > if 1st line,< x2 if 3rd line.
1/2 switch JAKi->TNFi
1/3 switch JAKi ->JAKi
Why high proportion of JAKi cycling, when AE reason for switch low?
https://t.co/APdWW7fzJE
Abst #0274 #ACR22 @Rheumnow @ClaireDeakin10 https://t.co/3xM3lQO1wI
Aurelie Najm AurelieRheumo ( View Tweet)
ACR Year in review J. Varga
What drives TNF superproduction in RA?
Study mice 🐁 model grafted w/ human synovial tissue suggests
important role of mitochondrial stress through aspartate deficiency
A potential new therapeutic target 🎯 RA?
@RheumNow #ACR22 #ACRyearinreview https://t.co/lKrOn05sFp
Aurelie Najm AurelieRheumo ( View Tweet)
Tissue-resident memory T cells (Trm):
☝️Do not recirculate by blood or lymphatics
☝️Can drive recurrent inflammation
☝️Fixed-drug eruption is an example
CD8Trm - abundant in late stage non-inflamed RA synovium
#ACR22 @RheumNow #yearinreview #RheumTwitter https://t.co/LfTI0LamkN
sheila RHEUMarampa ( View Tweet)
New 2022 EULAR Recommendations for the Management of RA
The updated '22 EULAR recommendations for the mgmt of RA were initially presented at EULAR '22, and are now in press delineating the most recent developments and perspectives in RA treatment.
https://t.co/xnpOUnpgvy https://t.co/OWcRq7nZ57
Links:
Dr. John Cush RheumNow ( View Tweet)
A group of older patients w/ multimorbidity (5+) drives higher mortality risk in RA.
Crowson et al. stratification 4 clusters. Each cluster = different outcome, younger cluster w/ few comorbidities = no > mortality
https://t.co/IYccicjcyy
Abstr #0246 #ACR22 @Rheumnow #ACRBest https://t.co/ee9sgG3g0l
Aurelie Najm AurelieRheumo ( View Tweet)
Yr in review #ACR22 @RheumNow
🌟GLORIA 2 yr data:
👉Pred 5mg OD vs PBO >65y/o RA
✅⬇️ disease activity (DAS28 -0.38)
✅⬇️ joint damage (sharp/van der heijde -1.7)
❌ 24% ⬆️ a/e
“Weigh success in benefit and failure in harm 2 individualise use of low dose pred in RA >65y/o”
Patricia Harkins DrTrishHarkins ( View Tweet)
Dr. C Langford on #YearinReview: ORAL Surveillance noted NNH=16 in pts w/ASCVD compared to NNH 223 in pts w/o ASCVD. This led to FDA warning on all JAKi; how does not this apply to the new JAKi's? Discussion needed with patients when starting this class of drug #ACR22 @rheumnow https://t.co/XtJVap6yjh
TheDaoIndex KDAO2011 ( View Tweet)
Dr. C Langford #YearinReview: RDBPCT on benefits/harms prednisolone 5 mg/day for 2 years added to SOC in 65yo+ with active RA. Results: improvement in DAS28 (0.37) but AEs occurred in 24% (infection, low bone density)—NNT 9. Study does not apply to younger pts. #ACR22 @rheumnow https://t.co/p2C6IfSje1
TheDaoIndex KDAO2011 ( View Tweet)
GLORIA trial showing low-dose addon pred in older patients with RA showing modest benefit (including reduction in damage) balanced against increased AEs (mostly infection); NNH 9.5!
@RheumNow #ACR22 #yearinreview #ACRBest
Julian Segan JulianSegan ( View Tweet)
Year in Review #acr22
Oral Surveillance:
With ASCVD number needed to harm 16, only 223 without ASCVD
Focus on risk stratification
@RheumNow https://t.co/tJyha1WKfR
Eric Dein ericdeinmd ( View Tweet)
ORAL surveillance the big talking factor over the last year.
NNH of 16(!) for CV event (over 5 yrs) in those with history of atherosclerotic CV disease.
@RheumNow #ACR22 #yearinreview #ACRBest
Julian Segan JulianSegan ( View Tweet)
Great start to year in review.
Beginning with JAKinibs in the much talked about ORAL Surveillance study.
Good Review of the mechanisms of action for JAKinibs
@RheumNow #ACR22 https://t.co/IF0t4uSefj
Robert B Chao, MD doctorRBC ( View Tweet)