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TM83 #ACR23 @RheumNow
45yo M b/l sacroiliitis, Rx MTX -> ADA -> MTX + Tofa. No improv
Low Ca, & Phos, ALP 239. Nml Vit D, High PTH.
DEXA: Osteoporosis
FGF23 high
PET/CT showed soft tissue density in nasal septum, few cortical breaks
Dx: oncogenic osteomalacia 2/2 malignancy https://t.co/EOcYNtovBy
Eric Dein ( View Tweet)
How do we treat #VEXAS - UBA1 mutation
Large multicenter cohort - 110 pts, 99% M
Confirms the benefit of JAKi and tocilizumab
Others not so much
@RheumNow #ACR23 #ACRBest
#abstL03 https://t.co/tRjO31IHiD
Bella Mehta bella_mehta ( View Tweet)
Interesting counterpoint to a tweet from a few days ago re:black box warning for JAKs
No change in utilization rates post black box... maybe people had already baked this into the cake by then?
@RheumNow #ACR23 Abstr 2142 https://t.co/K9cWbRSWV6
Mike Putman EBRheum ( View Tweet)
#ACR23 Late-Breaking Abstr#L09 In a crowded market, you’ve got to stand out. Phase 2 RCT of LNK01001, a highly selective JAK1-i in China: improvement in ACR 20,50,70 vs PBO at WK12. Those in PBO who didn’t meet ACR20 improved after receiving Tx. Very low infections @RheumNow https://t.co/ZbJFNHOtFT
Md Yuzaiful Md Yusof ( View Tweet)
A#L09 #ACR23 @RheumNow
New JAK! LNK01001
Chinese pts with mod-severe RA, csDMARD failures
12mg/24mg/PBO: W12: ACR20 60/73/31%, ACR50 40/42/9, ACR70 12/21/2%
Stat signif diff reached at wk 1 for ACR20!
Improved DAS28, HAQ-DI
Wk24 ext: 91% remain in ACR 20
AEs: HLD noted https://t.co/RXOMzxGOTy
Eric Dein ( View Tweet)
Phase 2 RCT. Selective JAK1i LNK01001 in RA. 156 patients, 24 week (12 week PBO controlled). Abstr#L09 #ACR23 @RheumNow https://t.co/hHjL1yFH0H https://t.co/Qls4zRrRGH
Richard Conway ( View Tweet)
#ACR BEST Abstracts from San Diego – Day 1
The RheumNow faculty reporters have been scouring the meeting for what they believe to be the best presentations from the first day at ACR 2023 in San Diego. From hundreds of online presentations, the poster floor and the plenary podium, here are some of the best abstracts from Sunday Nov. 12th. You can spot these on Twitter by looking for the (#ACRbest) hashtag.
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Crude drug retention at 1 year was 65% for JAKi, significantly lower than for other modes of action (74%) and TNFi (77%). These results are driven by the severity of the disease of patients on JAKi compared to other MOA. Aymon R Abst#1692 #ACR23 @RheumNow https://t.co/LPDpWdjoLg https://t.co/Ztaz94omd9
Dr. Antoni Chan ( View Tweet)
Sendaydiego et al. Comparative cancer safety b/tsDMARDs. 37,026 patient database cohort study. Compared to TNFi, RTX HR 2.2 (1.5, 3.3) ABA HR 1.7 (1.3-2.4), JAKi HR 1.3 (0.9-1.9). Abstr#1678 #ACR23 @RheumNow https://t.co/bTNtaNJrln https://t.co/qQBM2F2q8N
Richard Conway ( View Tweet)
Ritux (OR 2.2), ABA (OR 1.3), JAKi (OR 1.3) significantly increase risk of cancer vs. TNFi
Cohort of 37000+ RA pts starting bio/tsDMARDs (379 incident cancers)
True biologic effect or confounding by indication in a generally more comorbid population?
@RheumNow #ACR23 ABST1678 https://t.co/suj6mVBEC0
Aurelie Najm ( View Tweet)
#ACR23 Abstr#0840 Could combined JAK1/Tyk2 fare better than Tofacitinib in D2T #RA? Phase 2 RCT showed impressive results; > %50 pts in the higher doses TLL-018 arms achieved ACR50 vs TOF (42%). TOF non-responders at WK12 who switched to TLL-018 improved too @RheumNow #ACRBest https://t.co/Yw6Pvb2PH8
Md Yuzaiful Md Yusof ( View Tweet)
Insights into pathogenesis venous & arterial thrombosis in RA + JAKi
Significant dysregulation of clotting pathways in myeloid & increased clot formation in context of microbial challenge (TLR4)
Observed across all JAKI, but selective JAK3i
@RheumNow #ACR23 ABST1676 https://t.co/nboy0znfAW
Aurelie Najm ( View Tweet)
In PS-matched study, no significant difference in respiratory hospitalisation or death between RA-ILD patients on non-TNFi/JAKi vs. TNFi. This finding does not support systematic avoidance of TNFi in RA-ILD, England B Abst#1582 #ACR23 #ACRBest @RheumNow https://t.co/1zVjMWNZZS https://t.co/d8TRIvGaIe
Dr. Antoni Chan ( View Tweet)
Debaters and moderators acknowledge IL6i may not be the only steroid sparing agents that would work for #GCA. Abatacept, secukinumab, JAKi are being evaluated #greatdebate @rheumnow #ACR23
TheDaoIndex KDAO2011 ( View Tweet)
This is pretty nerdy, but I would love a documentary about filgotinib
JAK class wins/fails feel highly idiosyncratic to me
The difference between UPA & FIL from science perspective seems negligible; financially, it's many billions of $$$
@rheumnow #ACR23 Abstr 1325 https://t.co/efGwSSrxz7
Mike Putman EBRheum ( View Tweet)
Super interesting study re: impact of ORAL SURVEILLANCE on prescribing
Post safety report, JAK pts shifted younger w/lower comorbidities (esp CVD)
I know many have mixed feelings, but I believe in the risk & support this type of shift
@RheumNow Abstr0435 #ACR23 https://t.co/EBg9VOIbj1
Mike Putman EBRheum ( View Tweet)
ABS0450
⭐️Baricitinib non-inferior as well as superior to TNFi in terms of ACR50 response @ 12w in real world csDMARD refractory RA patients
➡️open-label, T2T w/ Baricitinib (n=102) vs TNFi (n=97)
➡️DAS28-CRP remission (<0.6) in 74% of Bari vs 47% of TNFi
#ACR23 @RheumNow https://t.co/yydS20hNzM
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
No more underpowered long-term safety studies
We need a "SELECT-SURVEILLANCE" study to replicate ORAL-SURVEILLANCE & tell us if UPA has the same MACE/cancer risk as TOFA
Minus that, I plan to go 100% TOFA when it becomes generic in 2026
@RheumNow #ACR23 Abstr1326 https://t.co/LyQ1Q8qReO
Mike Putman EBRheum ( View Tweet)
AS pts on UPA for 52 wks who were active or healthy weight/underweight at BL generally experienced greater decreases from BL in ASDAS-CRP and BASDAI vs pts who were inactive or overweight/obese. #ACR23 Abs #0540 https://t.co/OfgbmYUoAu @rheumno https://t.co/liptgbK2hJ
Dr. Rachel Tate ( View Tweet)
🔥 Absolute masterclass @philseo in the Clinical Year in Review #ACR23
➡️ Certain subpopulations have lower risk of AE with Tofacitinib
➡️ Knee OA 📈 75% by 2050
➡️ Exciting novel approaches in Rx of IA in development
➡️Better clinical trial endpoints needed for SLE https://t.co/5cjbZLPsCM
Caoilfhionn Connolly ( View Tweet)