For many years glucocorticoids were the mainstay of our treatment of granulomatosis with polyangiitis (GPA). The paradigm shifted with cyclophosphamide and then again with rituximab, and we used less steroids, but we still used lots. Avacopan teased the demise of steroids, but in the trial they, and now we, still use them. Glucocorticoids are our old trusty friend, our comfort blanket. But no more! Good riddance to the medication with the highest long-term adverse event burden that we use. Long-term glucocorticoids in GPA should now be a rarity. The reason for such exuberance is the TAPIR study presented by Dr. Peter Merkel at Saturday’s opening plenary session.
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Bimekizumab (BKZ) is a monoclonal IgG1 antibody that selectively inhibits interleukin (IL)‑17A and F. There have been more updates on the 2 year data on BKZ at #ACR24, and this is a summary of four studies being presented this year at ACR24.
Richard Conway
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Langford et al. Abatacept NOT effective in GPA in ABROGATE RCT. 65 patients. Relapse/worsening in 62% vs 68%. No difference in any secondary end-point. @RheumNow #ACR24 Abstr#0823 https://t.co/yRFZ2diJFF https://t.co/LgXkPnDArE
Antoni Chan MD (Prof)
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A systematic review highlights the impact of glucocorticoids (GC) during pregnancy and lactation. Increased risks of preterm birth were noted with GC exposure, advocating for minimized doses and pregnancy-compatible treatments. Encouragingly, low levels of GC found in breast milk… https://t.co/7CnJUBrUDQ https://t.co/ZeGHFHNT13
sheila
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Data from the study by Dr. Aguilar et al showed that high dose NSAID use was not assoc'd with incident HTN in their cohort of early axSpA patients.
Shows important role of NSAIDs in #axSpA but still should be used judiciously
@RheumNow #ACR24 abs540
@rheum_cat @rheumarhyme https://t.co/LK5yFZynu4
Richard Conway
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Galloway et al report OCP/HRT use in RA is not associated with VTE in UK population based study. Increased risk by having RA, HR 1.52. Risk OCP HR 1.43, HRT HR 2.32 - neither statistical significant but very wide CI's! Hmm... @RheumNow #ACR24 Abstr#0134 https://t.co/CZNoRfYWe8 https://t.co/uC6jA9lcX9
Antoni Chan MD (Prof)
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The risk of discontinuing first line biologics was twice higher in non-radiographic female patients compared to males. Abstr#0572 @RheumNow #ACR24 https://t.co/1tQUhsbqUu
Richard Conway
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Dhir et al. RCT of increasing folic acid from 5-10mg per week to 15-35mg per week if MTX intolerance. No benefit! Although significant placebo response and folic acid is relatively benign. @RheumNow #ACR24 Abstr#0525 https://t.co/D3yfV6a8t6 https://t.co/QpDa1alvMz
Antoni Chan MD (Prof)
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Data from the French DESIR cohort reveals no significant link between high-dose NSAID use and incident hypertension in patients with axial spondyloarthritis. Two thirds were high dose NSAID users at baseline. Incident hypertension occurred in 11% individuals during follow-up.… https://t.co/EAICDwzxNT
Richard Conway
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Serrano-Combarro et al. Abatacept in RA-ILD. 343 patients. In 23.3% ILD progressed on abatacept. Is that good or bad? We need comparative studies! @RheumNow #ACR24 Abstr#0475 https://t.co/nUEDdjGguA https://t.co/sXEF72MafK
Eric Dein
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Are you pts using cannabis?
In Canada - 20% reported using w/in past 2 years
Use for pain, sleep, anxiety
78% noted efficacy
Compare to another study said 57% stopped due to inefficacy, 28% AEs - very diff result
70% did not tell their doc
16S18 @BharatKumarMD
#ACR24 @RheumNow https://t.co/6NAECW5MJK
Richard Conway
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Serrano-Combarro et al. Baricitinib in RA-ILD . 72 patient case series. PFTs in picture. HRCT stable/improved in 72% over 24 months. Dyspnoea stable/improved in 90%. @RheumNow #ACR24 Abstr#0476 https://t.co/aVI2kRZkMN https://t.co/4l5GKsFKtm
Richard Conway
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Pasoto et al. Holding MMF for 1 week after zoster vaccine (RZV) improves response with no increase in flare @RheumNow #ACR24 Abstr#0247 https://t.co/q757bMFp7I https://t.co/rwjz3q3MaO
Eric Dein
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Pharmacologics:
Cannabis absorption and metabolism is variable
Inhaled absorption 10-35%
THC is 97% protein bound, lipophilic and deposits in fat and spleen
Liver function is critical for THC metabolism
16S18 @BharatKumarMD
#ACR24 @RheumNow
Richard Conway
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Quinn @KQuinnRheum @petercgrayson et al. FDG-PET is not particularly useful in monitoring GCA on tocilizumab. Toc reduces but often not eliminate PET inflammation. PET activity does not predict relapse or vascular progression @RheumNow #ACR24 Abstr#0742 https://t.co/1qcJCGV118 https://t.co/6mBCgcbYo6
Richard Conway
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Harkins @DrTrishHarkins et al. Serum disease activity markers in PMR. ROC analysis for active vs remission - fibrinogen (1.000), ESR (0.986), Haptoglobin (0.976), CRP (0.986), ALP (0.854). @RheumNow #ACR24 Abstr#0741 https://t.co/f8cX68Ov9Y https://t.co/zp5c7aQwxr
Richard Conway
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Dunn et al. Are the medications recommended for RA-ILD by the ACR guidelines used in the real-world. NO! 4108 RA-ILD patients. Only 12% on one of the first line recommended therapies! @RheumNow #ACR24 Abstr#0214 https://t.co/OzW90OA1Vd https://t.co/S1MKmEDrLF
Eric Dein
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IV or inhaled THC:
Works quickly with high peak, feel euphoric but not sustained response
Oral is much better for medicinal usage
@RheumNow #ACR24 https://t.co/3PatgEFjZh https://t.co/wrrLMpfL5D
Eric Dein
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How to take cannabis?
Do NOT rec inhaled
- makes drug level go up high/fast, benefit for rec use but not for medicinal
- bronchitis, ?oral cancer
Other risks: psychosis - risk in youth, memory loss (poor studies), dependence, respiratory if inhaled
Clauw 16S18 #ACR24
@RheumNow https://t.co/coYNl7VOT3
Richard Conway
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TAPIR study of continuing vs stopping steroids in ANCA vasculitis in remission. Relapse at month 6 in 16% vs 4%. OR 4.22, but low rate in either group. If treated Rituximab, no difference! Merkel et al. @RheumNow #ACR24 Abstr#0774 #ACRbest https://t.co/pKa4U5L2fW https://t.co/MjzE14SeGi


