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ORAL Surveillance - Is Statin Use the Problem/Solution?

Eric Dein, MD Nov 18, 2024

The findings from ORAL Surveillance Study have been a dominant conversation at recent ACR Convergence, with the seminal findings and subsequent analyses a target of debate. Subsequent post-hoc analyses, follow-up studies, and claims data analyses have been used to further interpret the data, though a clear answer on safety is not certain. A study presented on Sunday reported on a new post-hoc analysis that provides new insights.

@DianeLacaille Canadian biosimilar exp Biosimilar transition v originator controls x2 yrs Weighted model: no decr in ETN biosimilar discontinuation v originator. IFX shows slight decrease - NOT statistical signif Safety- no difference, slight incr rheum visits @RheumNow #ACR24 https://t.co/0GMfLAyzOo

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Updated ACR guidelines on management of lupus nephritis (LN). Consider early biopsy. Focus on triple therapy in LN. From the panel discussion, Tacrolimus can be an alternative to CNI (Voclosporin) where there is no access to this. Manage comorbidities such as CV risk, bone… https://t.co/4R02YnRXDP https://t.co/3J7YcF5ucQ

Galloway et al. 117,050 individuals. VTE risk in RA consistently increased, irrespective of age, sex, BMI. Risk VTE 46% higher in RA! @RheumNow #ACR24 Abstr#1901 https://t.co/SQPcPiBeF2 https://t.co/BQkERUsGlL

Do pts w autoimmune disease (AID) respond differently to immune checkpoint inhibitors (ICI) & have different mortality or iRAE risk vs pts without AID? Study of pts on ICI showed no significant difference in mortality in pts w & without pre-existing AID Ab2532 #ACR24 @RheumNow https://t.co/suywDdGIB1

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Overall very reasonable, aligning ACR recs w/other guidance groups & updated data Remember: guidelines are meant to be broken. Some patients can likely avoid pulse, others may need more steroid on the back end, biopsies are not benign #ACR24 @RheumNow

Recommend "Triple Therapy" = Glucocorticoids + two other agents Practically, that means MMF + belimumumab OR CNI for most pts For the CYC afficionados, the lower-dose EUROLUPUS protocol is preferred #ACR24 @RheumNow https://t.co/0gRISXSw0c

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Happening now, new guidelines for mgmt. A few highlights: Recommend prompt GC therapy, pulse x1-3d followed by oral pred (<0.5mg/kg/d) w/taper to <5mg by 6 months Aligns with EULAR recs for a much-lower dose than most clinicians currently doing #ACR24 @RheumNow https://t.co/B71i7FBYlQ

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Abstract 2503: Clofutriben (HSD-1 inhibitor) minimizes adrenal suppression. Adding clofutriben to prednisolone boosts ACTH & cortisol levels with fewer patients with suppressed morning cortisol (≤5.0 mg/dL) (34% vs 14%). @RheumNow #ACR24 #GCTox

Low uveitis rates in patients with axial spondyloarthritis and psoriatic arthritis treated with bimekizumab (BKZ) over the long term. Key findings: - AxSpA: 3.7% incidence (1.3/100 PY) with BKZ. - PsA: Only 0.2% incidence (0.1/100 PY). - All events were mild/moderate, with no… https://t.co/jkUwHJk3FJ https://t.co/gTcCzeC88e

Hyrich: ETN originator vs biosimilar initiation - DAS28 - no signif change at B/L, 6mo, 12 mo. Switch? Matched pts in ETN switch v cont originator - good b/l control on Rx -DAS28 maintained w switch 10% did go back to originator, felt less good tho similar DAS #ACR24 @RheumNow https://t.co/RHRit5CtUu

Early observational data suggesting JAK inhibitors can play a role in TAK tx We have seen this with UPA in GCA this conference… time for SELECT-TAK ! @RheumNow #ACR24 https://t.co/B2Wa8sOFTp

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Using longitudinal claims data, this study explores the safety of non-conventional combination targeted therapy in adults with psoriatic arthritis (PsA). Key findings: - 42,821 PsA patients analyzed; only 1.1% on combination therapy. - Increased risk of serious infections:… https://t.co/Jghmz9lkLd https://t.co/YqwJlTKcEi

Does adding a Clofutriben (HSD-1 inhibitor) w/ prednisone minimize the risks of steroid toxicities in #PMR patients? VS placebo, PMR patients who received Clofutriben + Prednisone had substantial reductions in bone, lipid, and glycemic control parameters @RheumNow #ACR24

Does vasculitis flare with checkpoint inhibitors? @MDAndersonNews experience: 17 stable pts 4 pts flared - all able to be controlled (i.e. 13 didn't flare) Encouragement that stable vasculitis pts that need ICI should get them! #ACR24 ABST1986 @RheumNow https://t.co/jO4w3HWBMd

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Risks for HCQ cardiotoxicity: 👉>5 yrs use 👉>5 mg/kg/d (cumulative dose >500,000 mg) 👉CKD 👉use NSAID 👉preexisting heart dz 👉presence of ocular, derm, SkM toxicity - Dr M Garschik #ACR24 @rheumnow https://t.co/LFobgls4jm

Dr. @karen_kc123 discusses the results of the VITAL study. - Long term use of Vit D3 2000IU was safe and decreased the incidence of all autoimmune dses by 22%. - It took a while to work but the effect dissipates once discontinued. @RheumNow #ACR24 @rheumarhyme https://t.co/mnwRsdZ06N

Study of 25K+ patients using TrinetX on immune checkpoint inhibitors shows no significant mortality difference between those with pre-existing autoimmune disease (AID) and those without. Mortality rates: AID: 39.8% Non-AID: 40.2% Large-scale evidence supports ICIs in AID… https://t.co/BI5jK9jsoM

https://x.com/i/web/status/1858529345834479759

A#2532 Pre-existing AID for immunoRx? Excluded from trials 4 prior studies showed no diff in mortality w AID Propensity-matched cohort study Followed median 250 days Hazard ratio: 1.07 (unmatched), 0.97 (matched) - no diff. Mortality about 40% in grps @RheumNow #ACR24 https://t.co/zyVCPts6s6

In earlier studies of Vit D, there were conflicting evidence as to whether it reduced or increased the risk of RA and #SLE @RheumNow #ACR24 @rheumarhyme https://t.co/PvjjmhHaOd

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ORAL Surveillance - Is Statin Use the Problem/Solution?

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