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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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Dual seropositivity and shared epitopes in RA: friends or foes?
Dual seropositivity (rheumatoid factor and/or anti-citrullinated protein antibodies) as well as shared epitope are known to be associated with poor prognosis and structural damage in RA.
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Greatest chance of sustained drug-free remission (DFR) is seen in early RA pts, NEVER requiring a biologic (esp if seronegative blue line). ERA on biologics never achieve DFR (yellow). Leiden EAC clinic study of 627 ERA pts Abstr# POS0615 #EULAR2024 https://t.co/zpCG6oSE3T
Dr. John Cush RheumNow ( View Tweet)
#SARD #ILD
Who to screen for #rheumatic #diseases
For
ILD
#ACR guidelines
Screening May also depend on ILD prevalence
Not sure if frequency of screening and how to screen
@jeffsparks #ORA24 @ORAexec https://t.co/BcyyYLKvr6
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Janet Pope Janetbirdope ( View Tweet)
Oral presentation at #EULAR2024 about clustering #RA #ILD 🫁 @PhilippeDieude @jeffsparks @RaphaelBorie @bruno_crestani https://t.co/jz1unKIZmN
PA Juge Juge_P_A ( 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
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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
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David Liew drdavidliew ( View Tweet)
What happens when RA patients only on csDMARDs want to stop their meds?
in BIO-FLARE, only half flared within 6mo of stopping all csDMARDs suddenly. They’ve got a clinical predictive model. Many milder patients ask, and could benefit!
#EULAR2024 POS0068 John Isaacs @RheumNow https://t.co/B7ZjP5Pj70
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David Liew drdavidliew ( View Tweet)
Risk of developing RA increased in antibody double-positive and single-positive compared to seronegative individuals. Highest risk in double-positive in first year. Single-positive increased risk of RA for up to five years after testing. In double-positive the risk remained… https://t.co/XLDHK4d4AE https://t.co/3Ek8knGExU
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Dr. Antoni Chan synovialjoints ( View Tweet)
OP0201- clinical characteristics of pts failing ≥2 b/tsDMARDs
D2T RA pts characterised by
⏰ Earlier disease
⏰ Later initiation of DMARD therapy
Discontinuation of drugs mainly due to inefficacy regardless of number of drug lines or MOAs used
#EULAR2024 @RheumNow
Mrinalini Dey DrMiniDey ( View Tweet)
OP0140-When should we give #pneumococcal #vaccine to pts starting MTX?
Study in RA:PCV13 vaccine given 1 month BEFORE starting MTX leads to higher immunological response at 1m, vs pts vaccinated simultaneously w MTX
⏩Vaccinate patients before starting MTX!
@RheumNow #EULAR2024
Mrinalini Dey DrMiniDey ( View Tweet)
When patients say their joints are swollen, what does it mean?
Easy to dismiss it as a symptom, but this clinically suspect arthralgia cohort from Leiden shows:
- some correlation with MRI/USS findings
- predicts RA development
still worthwhile!
#EULAR2024 POS0609 @RheumNow https://t.co/dw2p5Eo26C
David Liew drdavidliew ( View Tweet)
We’ve got better at treating RA over the last 20 years, and it’s genuinely saving lives.
Something to be very proud of. Let’s not forget that!
5y mortality from DANBIO 🇩🇰
(still, we still have work to do in seropos RA in men!)
#EULAR2024 OP0162 @RheumNow https://t.co/RfvABXhPvS
David Liew drdavidliew ( View Tweet)
#EULAR2024 @RheumNow https://t.co/nXpDI52R2U
Mrinalini Dey DrMiniDey ( View Tweet)
OP0181- What are the best drugs to treat D2T RA?
In this cohort of 185 pts, switching biologic or JAKi improved disease activity & was considered to be effective for patients with D2TRA, regardless of mode of action
@RheumNow #EULAR2024
Mrinalini Dey DrMiniDey ( View Tweet)
OP0165- incidence & risk factors of D2T RA in an early RA cohort
Factors assoc with D2T RA:
🩸 Seropositivity
🦴 Erosions
📈 Disease activity
📊 D2T pts have higher steroid doses & more commonly develop iatrogenic-related #comorbidities, e.g. osteoporosis
#EULAR24 @RheumNow
Mrinalini Dey DrMiniDey ( View Tweet)
I’ve always thought new RA meds get prescribed to the most risky patients, and therefore you see more adverse events.
Turns out it’s marginally true - maybe out to five years. Worth being careful of judging new meds too early!
#EULAR2024 OP0114 @karolinskainst @RheumNow https://t.co/Q8dIHiIYQk
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David Liew drdavidliew ( View Tweet)
#EULARBest
OP0156- validation & prevalence of D2T RA
Data from @BrighamResearch BRASS
In this cohort, the #EULAR definition of D2TRA correctly identified a subset of RA pts who have not achieved low disease activity despite multiple b/ts DMARD treatments
#EULAR2024 @RheumNow
Mrinalini Dey DrMiniDey ( View Tweet)
OP0137 is comparative analysis of clinical efficacy & drug retention of b/tsDMARDs
>1/2 D2T RA pts starting JAKi, RTX, IL-6Ri, or TNFi, but ~1/3 w abatacept, achieved remission or low disease activity in 6m & maintained consistent drug retention for 2yrs
@RheumNow #EULAR2024
Mrinalini Dey DrMiniDey ( View Tweet)
Is it worthwhile delaying MTX start for a month in RA, to vaccinate effectively?
VACIMRA (multicentre 🇫🇷) showed it marginally improves pneumococcal vaccine immunogenicity, persisting to 1y, no extra pred needed.
I’ll admit, I’m still not game!
#EULAR2024 OP0140 @RheumNow https://t.co/58qJxki8ov
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David Liew drdavidliew ( View Tweet)
