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Tofacitinib May Reduce Interstitial Lung Disease Risk in RA
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MedPage Today
Mar 23, 2023
Tofacitinib (Xeljanz) in patients with rheumatoid arthritis (RA) stood out among several other biologic and targeted synthetic disease-modifying antirheumatic drugs (sDMARDs) when it came to the incidence of interstitial lung disease (ILD), a retrospective cohort study showed.
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What to do about pre-clinical RA?
Mar 20, 2023
RheumNow Live’s 2023 conference led with this year’s hot topic of rheumatoid arthritis, and in particular, what to do regarding pre-clinical RA.
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Biosimilars are coming!
Multiple adalimumab biosimilars this year
- will we see a dramatic price difference?
@RheumNow #RNL2023 https://t.co/8vdtXtEGOO
Mar 19, 2023
Will be begin using sputum instead of blood serologies to detect RA?
- sputum seropositive CCP may be associated with development of clinical RA
- 4 fold higher risk if (induced) sputum CCP+
@RheumNow #RNL2023 https://t.co/Z85GDwIyl8
Mar 19, 2023
#RNL2023 Year in Review
Sputum antibody predicts future development of RA
Hazard ratio 4.2 if any sputum antibody positive (CCP IgG/IgA, RF IgM and IgA)
Strongest association with CCP IgA
Supports pre-RA as mucosal disease
@RheumNow https://t.co/Js4JPZiLDB
Mar 19, 2023
Smoking *may* only ⬆️ risk of #RA if shared epitope present AND double positive
By @Janetbirdope #RNL2023 https://t.co/TG1hseVCsD
Mar 19, 2023
Could MTX every other week dosing be an option in patients with stable disease..?
#RNL2023 https://t.co/EZRdQnuXjy
Mar 19, 2023
Long live the GOAT Rx: MTX 🐐🐐
History of usage dating back to 1950
Use 1st-line
Optimize dose
Supplement folic acid
Split dose
Give SQ
Use in combination therapy
Dr Joel Kremer #RNL2023 @RheumNow https://t.co/CCBvQoNHXo
Mar 19, 2023
#ClinicalPearl #Methotrexate weekly May reduce side effects in rapidly dividing cells vs using it daily or every few days. GI, oral, bone marrow side effects should be less if once a week. Joel Kremer @RheumNow #RNL2023 https://t.co/i0LZoQuK0w
Mar 19, 2023
How is a biosimilar approved?
Comparative effectiveness study for the reason that the medication was initial approved required, not for other indications
Jonathan Kay shows ex of ETN-ykro vs reference ETN in RA
Non-inferior in immunogenicity, safety, efficacy
@RheumNow #RNL2023 https://t.co/OOHie9Qr5t
Mar 18, 2023
Was amazed at the tons of biosimilar TNF options @_connectedcare uses in Australia... coming soon to the US!
Jonathan Kay #RNL2022 shows the lists of biosimilar
May be w/in batch-to-batch variability, unintended drift, or deliberate process changes (evolution)
@RheumNow https://t.co/sfVQspxbyr
Mar 18, 2023
Jonathan Kay on #RNL2023:
Biosimilar is well-researched with cost savings
These savings should benefit the patients
Incentives for physicians as well in form of decreased prior auth burdens
@RheumNow
Mar 18, 2023
RBC MTX polyglutamate levels may be the “truth serum” for those pts stating they are taking their MTX but you question it. Dr. Kremer @RheumNow #RNL2023
Mar 18, 2023
MTX is a prodrug!
MTX polyglutamate is true active ingredient
1/2 of MTX PG is 60 days, compared to only 6-8 horus for MTX
Steady state is not until 27.5 weeks!
Joel Kremer at #RNL2023 @RheumNow https://t.co/hodFZ2oi11
Mar 18, 2023
Do you stop MTX on patients on bDMARD?
MTX decrease anti-drug antibodies on patients on infliximab - increases drug duration.
Similar seen with new combination usage with pelogloticase
Joel Kremer MD
#RhuemNow @RheumNow https://t.co/8UrGZaFStA
Mar 18, 2023
How do you wean MTX?
Consider every other week dosing as options - supported by 2 randomized studies from 1995 and 1999
Option to lower weekly dosing in patients that want to take less often
Joel Kremer #RNL2023 @RheumNow https://t.co/3GMdn3lLhy
Mar 18, 2023
MTX lung disease:
Presents at 6-12 months
Baseline CXR is key to know if lung infiltrates are new
#RNL2023 @RheumNow https://t.co/Whu4O1GLA9
Mar 18, 2023
Do and don’t around MTX , Dr.Kremer approach to MTX #RNL2023 @RheumNow https://t.co/dXLQ0epsp4
Mar 18, 2023
@Janetbirdope at #RNL2023
RA is not a disease of young
Incidence increasing in elderly population, not often offered the full range of medications due to co-morbidities, despite safety data
Higher DAS, seroneg
Co-morbidities decrease outcomes
@RheumNow
Mar 18, 2023
Myths of RA by Dr. Janet Pope
- RA development should have ACPA years before?
- there is a significant minority of early RA patients who are seronegative!
@RheumNow #RNL2023 https://t.co/pnOxTkfW0l
Mar 18, 2023