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ACR21 – Day 3 Report
Hitting the home stretch, day 3 presentations were big! Here are a few of my favorites: secukinumab efficacy in juvenile PsA; VEXAS - predicting poor outcomes; and the FDA Safety Update session.
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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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Dr. Alexis Ogdie on opioid use in PsA and axSpA, highlighting need for better interventions.
🔹21% of PsA pts (n=828) and 27% of axSpA (n=334) reported prescription opiate use.
🔹⬆️BASDI & HAQ-DI =>⬆️opiate use & costs
https://t.co/Id658ocDVf
#ACR21 Abst1777 @RheumNow
Pedro Castillo _Castillo_Pedro ( View Tweet)
⭐️From 2012 – 2017 NIS data significant 🔽 in sepsis, SSTI, and UTI in patients with PsA despite the increased use of biologics over the years
⭐️No statistical difference pneumonia trend in PsA
Abst# 1783 #ACR21 @Rheumnow https://t.co/ToxgRb0acP
swethaann23 swethaann23 ( View Tweet)
Direct-to-Patient (DA) PsA Screening Survey sent to patients with Ps without PsA led to earlier diagnosis of PsA in 0.4%(n=1149 patients) as compared to 0.3%(n=1150) receiving standard of care (SOC).
Mean times to PsA diagnosis
66d ▶️ DA
77d ▶️SOC
Abst# 1781 #ACR21 @RheumNow https://t.co/qxjPCU0vnI
swethaann23 swethaann23 ( View Tweet)
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)
