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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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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With the advent of FDA-approved anti-obesity medications such as semaglutide and tirzepatide, a new avenue for managing this challenging patient population has emerged. But how might these drugs impact the trajectory of RA, and are we on the cusp of a paradigm shift?
David Liew
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Nice data from the OTIS Autoimmune Disease in Pregnancy Project re: certolizumab-exposed pregnancies:
- spontaneous loss rate comparable to non-disease controls
- no stillbirths
- preterm similar to disease controls
Plenty positive for CZP in pregnancy!
#ACR24 ABST0805 @RheumNow https://t.co/XCRYsioxC0
Antoni Chan MD (Prof)
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A study exploring the benefits of treating RA patients to remission after achieving low disease activity (LDA).
Key findings:
- Among patients initially at LDA, achieving remission (CDAI ≤2.8) led to significantly better functional outcomes and reduced durable medical equipment… https://t.co/SNPKlRieur https://t.co/YIQNMf3Oap
David Liew
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I have no doubt many of our RA patients will take GLP-1 agonists in the future.
Here's some data @UCLA showing significant differences in not just body weight and HbA1c, but pain.
Will be fascinating to see what it does for grumbling disease activity!
#ACR24 ABST2259 @RheumNow https://t.co/HdOPACEo3A
What is #healthliteracy? Why is it important for our patients with #RMDs?
Come to poster 1913 today at #ACR24 to find out about health literacy & outcomes in #InflammatoryArthritis
For more information on this important topic, read my article @RheumNow
https://t.co/llWs5aYtpK
David Liew
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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
David Liew
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"There's an app for that"
but is it enough?
US informatics national survey 2017-18:
Rheum pts with digital health tools weren't any healthier living than those without (maybe helps exercise)
It might be a conversation starter, but it's only an adjunct
#ACR24 ABST1929 @RheumNow https://t.co/EZpSwm0zuP
David Liew
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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
David Liew
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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
David Liew
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Now we have GWAS, we are getting polygenic risk scores for RA, and we can see what disease risks cluster with RA risk.
RA genetic risk clusters with risk for:
type 1 diabetes
thyroiditis
multiple sclerosis
What draws these diseases together?
#ACR24 ABST1365 @RheumNow https://t.co/28gU1nBEUG
David Liew
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Effective RA therapy is about more than just joints
🇪🇸 RA cohort
TNFi for first 24w led to:
Lean mass index i.e. muscle going up
Fat mass index i.e. fat trending down
Muscle & fat composition are important
Systemic Rx can deliver systemic benefits
#ACR24 ABST1348 @RheumNow https://t.co/mZjcHwxMgW
David Liew
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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
David Liew
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Dentition is important in RA, but it's easy to forget it's a matter of life or death.
NHANES data shows fewer teeth strongly correlates with higher mortality (esp cardiovascular).
Missing teeth = CV death HR >30
Holistic dentition is holistic RA care
#ACR24 ABST1325 @RheumNow https://t.co/Z40bSFybuS
David Liew
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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
David Liew
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Active early RA accentuates regional MSK pain.
Non-articular pain:
easy to ignore & focus on active RA
yes, some is related to RA dx activity
BUT actually it becomes a bigger issue over time
Worth identifying to:
clarify what isn't RA
Rx appropriately
#ACR24 ABST1335 @RheumNow https://t.co/iN5rsyr7Bx
David Liew
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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
Richard Conway
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My ramblings on the SELECT-GCA study and predictions of the place of upadacitinib in clinical practice in GCA are up now on RheumNow #ACR24 @RheumNow https://t.co/DR5VgVmdse
Richard Conway
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I've shared some further thoughts on @jeffsparks SAIL-RA study and its finding of the strong association of RA-ILD with disease activity in early RA. And of course couldn't resist going on a tangent about the ACR ILD guidelines! #ACR24 @RheumNow https://t.co/UUDbWw38Im
