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Day 2 Report - ACR Plenaries: Changing the Practice of Rheumatology
Over the years of navigating the annual meeting, I found the sessions with the most impact to my practice were the Plenary Sessions. During these sessions, the latest research is presented, new ideas are floated, and old myths debunked. Here are the top ACR2023 Plenary abstracts I found impactful for my practice.
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GCs on MACE in RA in VA
A#2430 #ACR23 @RheumNow
Not just ongoing steroid usage, also prior usage 1 year ago
5 mg use for 30 days one year ago - increases MACE events by 3%
5 mg use for 90 days one year ago - increases MACE events by 9%
Eric Dein ( View Tweet)
Wallace et al. Dose, duration, recency dependent relationship between GC and MACE. Even 5mg/day, 30 day use, and use 1 year prior associated with risk. 5mg, 7.5mg, 10mg pred for 90 days - 13%, 19%, 27% MACE increase Abstr#2430 #ACR23 #ACRbest @RheumNow https://t.co/50B5nGqxu9 https://t.co/lNrUbZOm0o
Richard Conway ( View Tweet)
A#2429 #ACR23 @RheumNow
ROMO v DEN - 12 mo RCT 70 GIOP pts at high-risk
Mean prednisolone dose 6.6 mg
H/o fragility fx in 1/2 pts
12 mo: Increase in spine BMD- ROMO (+7) and DEN (+2)
Hip and Femoral neck improved both (1.6% both), not signif diff bw grps
AEs: incr injxn site rxn https://t.co/VueuZIjFfM
Eric Dein ( View Tweet)
#ACRbest Abstracts – Day 2
Our reporters have been prolific in finding the hot abstracts, those that were most attended or those that are getting the most buzz on social media. Here are RheumNow's #ACRbest abstract reports from Monday, November 13, 2023 at #ACR23, covering The Great Debate, SGLPT2 inhibitors in SLE, the SMART Study of MTX, TMP/SMX Prophylaxis, RA-ILD & TNF Inhibitors, cancer research and more.
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ACR23 – Day 1 Report
ACR 2023 is back in San Diego for its annual convergence of thousands of rheumatologists to partake, discover and learn from thousands of abstracts and hundreds of sessions and presentations. It was a big return for the Poster Hall with rows and rows of research, friends, fellows and poster tours. Below are a few of my favorite presentations from the posters, Plenary and oral sessions on day one.
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Upcoming Plenary II session
Ab#1584 on Bactrim for GPA pts on RTX
Should you use this for prophylaxis after weaning the prednisone?
#ACR23 @RheumNow
Eric Dein ( View Tweet)
Glucocorticoids-free zone in SLE?
For over 70 years, glucocorticoids, (GC) have been a part of standard therapy in SLE. They are classically used to not only induce remission or treat an acute flare, but also as maintenance therapy. #ACR23
https://t.co/sfRhNj6OpZ https://t.co/k6VoG5lKO7
Dr. John Cush RheumNow ( View Tweet)
How does Dr. Robert Spiera manage GCA?
1) Tx with steroids alone, taper by 6 months
2) Do not chase ESR/CRP
3) Pay attention to steroid complications
4) Low threshold to use IL-6i
Similar plan for PMR
Taper steroids by month 4
@RheumNow #ACR23 https://t.co/KSwyfjobFY
Robert B Chao, MD ( View Tweet)
Debaters and moderators acknowledge IL6i may not be the only steroid sparing agents that would work for #GCA. Abatacept, secukinumab, JAKi are being evaluated #greatdebate @rheumnow #ACR23
TheDaoIndex KDAO2011 ( View Tweet)
#GCA Rx #bDMARD is established to #steroid spare and reduce relapses. #Tocilizumab #GiACTA Dr Seo said ‘biologics work and steroids are bad!’ @ACRheum @RheumNow #ACR23 #ACRbest https://t.co/JmSE1KKlf5
Janet Pope ( View Tweet)
The Great Debate #ACR23 - and it’s a cracker.
Is early steroid-sparing therapy justified in GCA/PMR? I don’t know, but Rob Spiera and @philseo will battle it out to tell us.
(and ably moderated by the always eloquent @SattuiSEMD)
I’ll put some highlights here ⬇️🧵
@RheumNow https://t.co/ASpuglyENv
David Liew drdavidliew ( View Tweet)
Baseline vascular ultrasound predicts clinical outcomes @ 3 months. Subclinical GCA = relapse 37% vs 15%. Higher cumulative steroid dose. @sharoncowley01 @DrTrishHarkins Abstr#1565 #ACR23 @RheumNow https://t.co/b35CkFS0lz https://t.co/suBGR1ByDK
Richard Conway ( View Tweet)
So firstly the no case, and Rob Spiera takes up the case, dictated by the electronic coin toss.
No-one disagrees that we need steroid-sparing options, or that IL-6Ri work in PMR and GCA. But it’s the strategy questions which remain in play:
#ACR23 @RheumNow https://t.co/I2QDU7l6DE
David Liew drdavidliew ( View Tweet)
Real World SLE Rx patterns from the SPOCS cohort. 70+% IFN high, 81% on antimalarials, 21% biologics, and 55% IS, 65% GCs. High IFN pts had more IS and steroid use. 45+% still on GCs at 12 months despite avail of new therapeutics @RheumNow #ACR23 abst#0592
TheDaoIndex KDAO2011 ( View Tweet)
Sunday recap @RheumNow
Very interesting abstracts:
https://t.co/BX8bDSX1M3
1- Fecal calprotectin in SpA population.
2-SLE; high or low steroids? Rapid or slow taper?
3-Molecular biomarkers for PAH in SLE.
4-Repeating imaging in ? Chronic back pain?
And others …….
Nouf Al hemmadi ( View Tweet)
#ACR23 Abstr#0784 Beyond renal response, let’s also focus on kidney function and Steroid-sparing effect. Post-hoc analysis of Phase 2 RCT showed Obinutuzumab preserved eGFR by 4ml/min/1.73m2/year with greater number of pts achieving <7.5mg/d of prednisolone bs PBO @RheumNowNews https://t.co/2hW74UF1ta
Md Yuzaiful Md Yusof ( View Tweet)
20 years real-world data on disease burden, patient experience & unmet needs in Refractory #RheumatoidArthritis
▶️Higher glucocorticoid & opioid use
▶️Greater comorbidity & symptom burden
▶️More rheumatology visits
#ACR23
👉🏽https://t.co/CAUorjQbvN
by @KristinWipfler @Dr_K et al https://t.co/vx1aOZizfE
Dr Ai Lyn Tan DrAiLynTan ( View Tweet)
#ACR23
Scleroderma renal Crisis (SRC)
May precede skin involvement also.
RISK FACTORS
• Early diffuse skin disease
- 2-3 years from SSc onset, median 8 months
• Anti-RNA polymerase III (60%)
• Use of corticosteroids
- >15 mg/d or low doses for longer time https://t.co/RSIxEXLdX7
Aditya Burje AdityaBurje ( View Tweet)
Are we tapering steroids too rapidly? Real world experience: steroid tapering in severe #AAV based on #PEXIVAS protocol noted higher rates of dz progression, relapse, ESRD, death. Risk greatest when creatinine > 300umol/L and w/RTX induction #Plenary1 #ACR23 Abst#0725 #ACrBest https://t.co/Rtv7vkzUUD
TheDaoIndex KDAO2011 ( View Tweet)