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ACR23 – Day 3 Report
These year’s annual ACR Convergence has been a success with the return of an insanely active Poster Hall! F2F learning amidst miles of research and many young talented aside wizened establish presenters is such a welcome return to ACR, the way it should be.
Read ArticleShould We Change How We Prescribe Methotrexate?
For as long as I can remember, methotrexate has been the anchor drug treatment of rheumatoid arthritis. We also know it has limited oral bioavailability at doses greater than 15mg. There are subcutaneous forms that offer better bioavailability, but its subcutaneous nature can sometimes sway patients away from trying it in addition to its higher cost. Split dosing of methotrexate can be a solution to attain higher bioavailability; however, its effect on clinical efficacy is unknown.
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Fecal microbiota - can it predict development of RA?
Sadly, no. Despite promising mouse work. Despite relative control of exposure & genetic enrichment incl SE. Not even Prevotella. Maybe if you compare the most extreme cases
but it’s not all the gut.
#ACR23 ABST2584 @RheumNow https://t.co/VgDZaH9kvo
David Liew drdavidliew ( View Tweet)
Pre-clinical RA trials roundup, but also:
Great use (and acknowledgment) of RheumNow slide in the abstract background. Glad to see it being helpful there!
#ACR23 ABST2585 @RheumNow https://t.co/sK6bDJrYjV
David Liew drdavidliew ( View Tweet)
Treatment of RA-ILD patients with ABA at any time of the course in the ILD seems to prevent interstitial lung progression. The evolution of FVC and DLCO for 48 months remained stable with ABA therapy. Serrano-Combarro A, Abst#2173 #ACR23 @RheumNow https://t.co/QE61wzKWXi https://t.co/xd3wvMXUlA
Dr. Antoni Chan ( View Tweet)
L20 #ACR23 @RheumNow
Telitacept - Recomb Fusion targets BlyS, APRIL in RA w inadeq MTX response
ACR 20 60% v 27% PBO (p<0.001), ACR 50 21% v 6% PBO (p<0.001)
DAS28-ESR <3.2 15% v 5%, reduct -1.6 v -1.0
Better PROs, less jt damage prog at w24
Safety SAE 6.4 v 6.7%, no ifn signal https://t.co/PsA6AxUHVW
Eric Dein ( View Tweet)
#ACR23 Late-Breaking Abstr#L20 Phase 3 RCT in China: Telitacicept (BAFF-APRIL-i) in MTX-IR #RA met ACR20 response vs PBO.
+ve: less radiographic damage
-ve: lower rate ACR50 (21%), homogenous population, no H2H active comparator
Unclear its place in current Mx @RheumNow https://t.co/SAc4B1aRD1
Md Yuzaiful Md Yusof ( View Tweet)
Telitacicept (BlyS/APRIL inhibitor) ph3 in RA
wholly in China, after SLE approval there (SLE trial now w global sites)
Efficacy okay, no better than other b/tsDMARDs
What's the hook here, in a crowded RA market incl biosimilars?
Safety does look good though
#ACR23 L20 @RheumNow https://t.co/UzQ0f18E2A
David Liew drdavidliew ( View Tweet)
Interesting late breaker!
Telitacicept - recombinant fusion protein targeting BLyS and APRIL for treatment of RA
Phase 3 study - at wk 24, reached ACR20, ACR50, DAS28-ESR, no radiographic progression
No difference in safety profile compared to placebo
@RheumNow #ACR23 #ACRBest https://t.co/bxWPagGixt
Robert B Chao, MD ( View Tweet)
Telitacicept (BlyS/APRIL inhibitor) in MTX-IR RA. Phase 3 RCT. 479 patients. ACR20 60.0% vs 26.9%. ACR50 21.4% vs. 5.9%. Radiographic benefit also. Safety looks ok. Abstr#L20 #ACR23 #ACRbest @RheumNow https://t.co/qcinGeRX2d https://t.co/SIKKW7xhwV
Richard Conway ( View Tweet)
Tommasi et al. MTX (vs SSZ) lowers BP in RA in RCT. At 6 months, significant reduction in SBP (mean difference -4.0±10.8 mmHg, p=0.038), MAP (mean difference -4.3±17.9 mmHg, p=0.023). Abstr#2151 #ACR23 @RheumNow https://t.co/wAX3dCztxH https://t.co/mPG5TdeHTu
Richard Conway ( View Tweet)
New MoA in RA 🚨
Dual inhibition BAFF/BLys Telalicept MTX IR pts Ph3 vs. PBO
ACR20 60 vs. 27%
ACR50 21 vs. 6%
DAS28<3.2 15 vs. 5%
Less Rx prog
Safety similar infection rates
@RheumNow #ACR23 ABSTL20 https://t.co/WHysLSKyo0
Aurelie Najm ( View Tweet)
Serrano-Combarro et al. JAKi in RA-ILD. 73 patients on JAKi (74% Bari). Many had prev received abatacept/rituximab. HRCT improved/stable in 76%. Dyspnoea stable/improved in 95%. Abstr#2174 #ACR23 @RheumNow https://t.co/j6SiEzSRif
Richard Conway ( View Tweet)
Long-term abatacept in UIP RA-ILD. 233 patients, median 22 month follow-up. Sustained benefits to previous data. ABA was withdrawn in 50 patients (21.5%) (ILD worsening 20, joint worsening 15, serious infections 7, others 8) Abstr#2165 #ACR23 @RheumNow https://t.co/SinE4GgFRE https://t.co/M1Nnce58OE
Richard Conway ( View Tweet)
Window of opportunity for abatacept in RA-ILD. Early treated patients (<6 months vs >2 years) appear to do better in terms of FVC. Abstr#2173 #ACR23 @RheumNow https://t.co/14IsA1KbAk https://t.co/ZbZEwzaOu0
Richard Conway ( View Tweet)
L20 @ #ACR23
New therapy on the horizon for RA pts that failed MTX?
⭐️Telitacicept = recombinant fusion protein targeting & neutralizing BLyS & APRIL
➡️ placebo-controlled, phase III trial, 24w
👉at wk 24, PBO pts switched to drug arm for 24 more wks
➡️ 479 pts w/… https://t.co/94MyC8sdaG https://t.co/x3MUmFJPK6
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
Interesting look into autoantibody profile of rheumatic disease-ILD compared to IPF
Identified 7 ab in RD-ILD, emphasizing lack of autoimmunity in IPF
Different mechanisms of damage and progression based on ab profile?
@RheumNow #ACR23 Abs#2572 https://t.co/5rtXnOe9oJ
Robert B Chao, MD ( View Tweet)
Will CAR T Cells also treat RA?
Dr. Jonathan Kay reports on abstract 0424 from #ACR23.
https://t.co/XvNMXAFkWe https://t.co/HVvBLhqe8H
Dr. John Cush RheumNow ( View Tweet)
Auricular vagal nerve stimulation did not meaningfully improve RA disease activity. Further research of the novel intervention is required in RA, Baker MC, #ACR23 @RheumNow https://t.co/agLtRKdDTf
Dr. Antoni Chan ( View Tweet)
🆕 2023 ACR Guidelines for Management of Interstitial Lung Disease (#ILD) in Systemic Autoimmune Rheumatic Diseases 🫁
🔸 Screening & Monitoring Recs
🔸 Treatment Guidelines ILD/RP-ILD
#RheumTwitter #PulmTwitter #MedTwitter #MedX https://t.co/JreVO0kgEf
Mithu Maheswaranathan, MD ( View Tweet)