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Might Synovial Biopsy Predict Rheumatoid Treatment Responses?
EurekAlert!
Multi-modal analysis of rheumatoid arthritis (RA) synovitis pathotypes enables more accurate choices of first line cDMARDs treatment, suggesting a predictive value to synovial biopsy.
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EULAR 2024 – Day 2 Report (A Difficult RA Day)
Day 2 at EULAR 2024 was a big poster day for many with several good sessions and oral presentations on Preventing RA, new vasculitis therapies and a session devoted to the 50th anniversary of the Moll & Wright Criteria.
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Can we withdraw treatment in post-menopausal osteoporosis?
EurekAlert!
Analysis of French claims data, found over half of women initiating oral bisphosphonates (BP) between 2015 and 2020 discontinued treatment for at least one year, which was associated with a 12% increase in fracture risk.
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EULAR 2024 - Day 1 Report
Wednesday was Day One at EULAR 2024 in Vienna. While the day was a slow start, the poster halls and auditoriums quickly filled with thousands of rheumatologists, eager to reunite at this international educational forum. Below are a few of my favorites from Day 1.
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#EULAR2024 POS0390 What impact of regulatory warning on JAK-i on access to therapy? Data from UK BSSR-BR reported 4 in 5 #RA patients would have been considered ‘high-risk’. Of these, 28% had failed ≥3 biologics; so no suitable alternatives. Enormously impacted @RheumNow https://t.co/XeS9qHXSpH
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
Approach to TB screening prior
to commencing biologics. Hyrich K #EULAR2024 @RheumNow https://t.co/j3PI0PHpqW
Dr. Antoni Chan synovialjoints ( View Tweet)
The art of talking about risks with our patients
https://t.co/V0JQ1EsbKc https://t.co/GSTbPu0EXZ
Dr. John Cush RheumNow ( View Tweet)
#EULAR2024 Please find our Day 1 & Day 2 Recap of selective abstracts/research presented at the conference 😃@RheumNow @DrMiniDey
https://t.co/AHl18gS7gF https://t.co/LEoa9rBNly
Links:
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
The fracture risk with glucocorticoids is dose dependent. Lems W #EULAR2024 @RheumNow https://t.co/TGjKu1vfXx
Dr. Antoni Chan synovialjoints ( View Tweet)
Long term safety of bimekizumab (BKZ) in ankylosing spondylitis (BE AGILE) study (n 296) shows sustained ASAS40 efficacy @wk 48 (52%) & wk256 (50%). Low AE for candidiasis (2.6%), SIE (1.4%), IBD (0.8/100PY), Uveitis (0.7/100PY) Abst# POS0215 #EULAR2024 https://t.co/9PWey3itu9
Dr. John Cush RheumNow ( View Tweet)
I was allocated to bring down the warning, & I did apologise up front to both the EMA and Janet #EULAR2024. It's a tough gig regulating impactful medicines with risk-benefit, especially when our world is full of other medicines with risk-benefit trade-offs (like prednisolone). 2/ https://t.co/6YPhYHbhg8
Links:
David Liew drdavidliew ( View Tweet)
So how do we get from slightly increased numbers of uncommon events in a single study (ORAL Surveillance)?
Regulators think differently to us, which partly is the difficulty of a restrictive warning.
So being the Aussie I am, I asked - does it pass the 'pub test'? 4/ #EULAR2024 https://t.co/Ih9H87wH22
Links:
David Liew drdavidliew ( View Tweet)
Having said that, the EMA warning has elements making it extremely tough:
- still very broad criteria that capture 80% of people who were starting JAKi
- the need for "no suitable treatment alternatives" before using a JAKi, right across all diseases (not just RA) 3/ #EULAR2024 https://t.co/IsrYO7qzqM
Links:
David Liew drdavidliew ( View Tweet)
So I think there is plenty we could do instead.
better regulation
better risk stratification
better counselling
better risk factor management
(and definitely read this if you want to be a good clinician: https://t.co/RA6ktQB7gm)
18/ #EULAR2024 https://t.co/bC5nmi8SoM
Links:
- The Art of Communicating Risk and Benefit to Promote Shared Decision‐Making, In…
- https://twitter.com/drdavidliew/status/1801144689774735739/photo/1
- https://twitter.com/drdavidliew/status/1801144689774735739/photo/1
- https://twitter.com/drdavidliew/status/1801144689774735739/photo/1
- https://twitter.com/drdavidliew/status/1801144689774735739/photo/1
David Liew drdavidliew ( View Tweet)
Here's my 'pub test' for whether the warning is appropriate. And, debate aside, I do believe that it behoves any regulator to consider the unintended consequences of their regulation, because regulation has real consequences. 5/ #EULAR2024 https://t.co/aurbAwgl9P
David Liew drdavidliew ( View Tweet)
“One way to get rid of TDM is to get more drugs, and that’s what we’re doing”
- Gertjan Wolbink, the godfather of rheumatology therapeutic drug monitoring (TDM)
#EULAR2024 @RheumNow https://t.co/SYM8hjMMPJ
David Liew drdavidliew ( View Tweet)
In the ‘why therapeutic drug monitoring’ debate, we’ve heard a lot about TDM utility, but the con argument is interesting.
Desiree van der Heijde compares TDM to IL-6 levels, which never displaced her DAS
then puts up some confronting points. Interesting
#EULAR2024 @RheumNow https://t.co/7zomungi3e
Links:
David Liew drdavidliew ( View Tweet)
AMPLIFIED RCT, 300+ pts
ABA NOT (!) superior to ADA
in dual seropositive SE+ MTX IR RA pts
ACR50 rate high in both gps ABA 59% vs ADA 64%
No new safety signal
Defeating the encouraging data from smaller trials
Abstr#OP0007 #EULAR2024 @RheumNow https://t.co/PvRUnpthHl
Aurelie Najm AurelieRheumo ( View Tweet)
I chaired great debate at #EULAR2025 - JAK Inhibitor Special Warnings: can observational data debunk an RCT? Drs Janet Pope(NO) vs David Liew(YES). Voting suggests most are concerned about JAK warnings, but Liew won by converting a minority his way @janetbirdope @Drdavidliew https://t.co/bV1JdO7c4e
Dr. John Cush RheumNow ( View Tweet)
EULAR 2024 kicked off with a fantastic debate between Janet Pope and David Liew - ‘JAK inhibitor special warnings: Can observational data debunk an RCT?’
A thought-provoking discussion summarising all aspects of the ongoing conversation on JAKi use in high-risk patients! https://t.co/MzW3jSSCfr
Links:
The Immune-Mediated Inflammatory Disease Forum IMIDforum ( View Tweet)
