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Monitoring Infliximab Drug Levels Improves Efficacy
Should we start considering therapeutic drug monitoring when prescribing TNFi for treatment of our rheumatologic conditions?
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Hospitalisation for heart failure ⬆️ in inflammatory diseases. RA>PsA>AS>PsO . HRs 1.1-1.6 compared to general population. Abstr#1925 #ACR21 @RheumNow https://t.co/kKlGQM5Tcg
Richard Conway RichardPAConway ( View Tweet)
Why is there more CHF in #RheumatoidArthritis ? Also dose response between highest inflammation RA the PsA then axSpA then PsO. ?Cytokine profile varying with disease and maybe CRP. Who knows. Abst#1925 #ACR21 @RheumNow https://t.co/JIH3qwkLpx
Janet Pope Janetbirdope ( View Tweet)
Should we be measuring drug levels in pts taking infliximab?
⭐️Drug monitoring vs. standard dosing showed 73% sustained control vs. 55% (RA, PsA, SpA, UC, Crohn's, PsO)
#ACR21
Abs#1946
#ACRBest @RheumNow
https://t.co/sWMen50ljP https://t.co/F4Wpqis3id
Links:
Robert B Chao, MD doctorRBC ( View Tweet)
Prospective study of PsO screened @ derm clinics
🔹PsO➕>3 mo back pain starting <45yo➕no biologics➡️rheum ref, 100 pts seen➡️19 dx'ed as:
🔹14 axPsA, 68% met axSpA ASAS, 11/14 w/o pPsA
🔹5 pPsA w/o axial dz
https://t.co/azoks5CHCP
#ACR21 Abst#1796 @RheumNow
Pedro Castillo _Castillo_Pedro ( View Tweet)
Elevated CRP levels (>3) in PsA associated with ⬆️risk of cardiovascular events
⭐️NSAID use significantly REDUCED risk of CV events
Abs#1920
#ACR21 @RheumNow
https://t.co/gIz9f4SlWo https://t.co/V4uDeO3Iuz
Links:
Robert B Chao, MD doctorRBC ( View Tweet)
Racial differences in PsA patients in large US real world database
95% Whites (W) and 5% were AA
NSAIDs: 80% W and 78% AAs
TNFI: 51% W and 41% of AAs
DMARDs: 72% of W and 98% of AAs
HTN/DM/Obesity/Gout 🔼 AA
Cancer/osteoporosis /anxiety 🔼 whites
Abst#1780 #ACR21 @Rheumnow https://t.co/7ee4bVU7ZA
swethaann23 swethaann23 ( View Tweet)
PsO vs PsA patient and disease characteristics COPPAR registry:
PsO pts 🔼mean BSA
Both 🔼 % of biologic therapy
sPGA and PASI 🔼PsO
🔽QOL and physical health in PsA
🔼daily work impairment PsA
Abst # 1779 #ACR21 @RheumNow
swethaann23 swethaann23 ( View Tweet)
⭐️Ustekinumab+MTX vs. UST+PBO in PsA?
➡️Additional MTX has no positive impact on UST efficacy for arthritis, enthesitis, dactylitis, skin, QoL, & function.
*️⃣Thus, no evident to add or maintain ongoing MTX when starting UST
Late-Breaking Poster#12. #ACR21 @RheumNow #ACRBest https://t.co/k96PPUtwct
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
Retrospective cohort study FORWARD databank :
⭐️ 🔼opioid use was associated with higher HAQ-DI and BASDAI scores among patients with PsA or AS
Annualized avg opioid use and costs 🔼with 🔼HAQ-DI and BASDAI scores for patients in both cohorts
Abst#1117 #ACRBest @RheumNow https://t.co/KB9QUITbAe
swethaann23 swethaann23 ( View Tweet)
*️⃣Abst#1800 observed that a changing pattern of purine, lipid, & amino acid metabolites occurred during transition from PsO to PsA.
*️⃣Compared to pts w/ Pso that didn't progress to PsA, those that progressed had elevated levels of guanine!
Potential biomarkers?
#ACR21 @RheumNow https://t.co/iQh1ZapDMB
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
⭐️Immune phenotyping of 45 patients with Pso and 41 PsA pts showed a number of cell subsets significantly different in Pso vs PsA
⭐️Future possibility of using a combination of selected immune cell subsets as a method for detecting PsA in Pso pts
Abst#1774 #ACR21 @Rheumnow https://t.co/ER1MPOvMa6
swethaann23 swethaann23 ( View Tweet)
Abst#1774 identified a blood-based immune profile with a machine-learning approach that discriminates PsA from Pso.
➡️↑ proportions of differentiated CD4+CD196+CD183–CD194+ and CD4+CD196–CD183–CD194+ T-cells in PsA
#ACR21 @RheumNow https://t.co/64uhJCd2qo
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
#Guselkimab Better than #ustekinumab for skin& MSK. #Ixekizumab beat ustekinumab for skin. #ustekinumab loses throne in #psoriasis and #psoriatic arthritis except maybe if concomitant inflammatory bowel disease post TNFi? Rapidly evolving PsA Rx. Abst#1773 #ACR21 @RheumNow https://t.co/Dkf2DFFsSK
Janet Pope Janetbirdope ( View Tweet)
All for one or one for all? Lumper or splitter? Highlight from #ACR21 was session 6S403 looking at axial involvement in AxSpa vs PsA. I share my thoughts here at https://t.co/i2nDvMklee @RheumNow https://t.co/62tRRiAcUJ
Dr. Antoni Chan synovialjoints ( View Tweet)
Dr. Atul Deodhar with an excellent presentation on treatment in axSpA and axPsA. Note ustekinumab and risankizumab did not show improvement in axSpA. However, these studies did not include axPsA.
@ACR21 6S403 @RheumNow https://t.co/F73lvpF2at
Pedro Castillo _Castillo_Pedro ( View Tweet)
OK is this a swan or a swan song? Graph looks like a swan 🦢 but message is NO #MACE differences in PsA on csDMARDs v #biologics #ACR21 abst#1833 @RheumNow https://t.co/TM91z5wiFY
Janet Pope Janetbirdope ( View Tweet)
So are we in an era of #monotherapy with bDMARDs in #PsA? Ustekinumab & Secukinumab not different w or without #MTX. Abst#L12 @RheumNow #ACR21 https://t.co/Zp5owTpLvm
Janet Pope Janetbirdope ( View Tweet)
Cycling bDMARDs in #PsA. Law of diminishing returns. The more you fail, the more you cycle BUT can we break cycle by ⬆️adherence & health literacy, d/c smoking, use drug levels, biomarkers. Oh that in in future #ACR meetings! #ACR21 abst#1830 @RheumNow https://t.co/GyhgUGHWe8
Janet Pope Janetbirdope ( View Tweet)
Increased age at PSO diagnosis was significantly associated with shorter transition time between PSO and PsA diagnoses. No other variables, including BSA, were associated with time to transition @RheumNow #ACR21 Abst#1798 https://t.co/fLPBHKAMAc
Dr. Antoni Chan synovialjoints ( View Tweet)
