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When thinking of GCA there are only 2 questions you need to ask. Dr. @philseo reminds us to
1. Establish if new or recurrent disease
2. Assess for presence of visual symptoms
#RNL2024 @RheumNow https://t.co/MGML3EafPu
Dr. Rachel Tate uptoTate ( View Tweet)
How I do it, treatment of CGA with Dr. @philseo, who thoughtfully paused so everyone could take a picture of this slide knowing full well it was already at our fingertips! Such a gentleman!
#RNL2024 @RheumNow https://t.co/8kqacqkRM6
Dr. Rachel Tate uptoTate ( View Tweet)
Dr. Phillip Seo contemplates if Taylor and Travis had vasculitis, surely the dose for each would not be the same. Wish you were here @rheum_cat to weigh in on this. #RNL2024 @rheumnow https://t.co/1ynctgIknx
TheDaoIndex KDAO2011 ( View Tweet)
Dr @anisha_dua's takehome points for treating GPA in 2024
*RTX and CYC are both effective followed by RTX at least 500mg q 6 mo for at least 2 years
*PLEX not generally used, but may be effective in preventing ESKD
*Rapid GC tapering may not be suitable for all pts
*Avacopan is… https://t.co/haI19Sgpmu https://t.co/jhjXLwd0Uw
Dr. Rachel Tate uptoTate ( View Tweet)
Dr @anisha_dua's takehome points for treating GPA in 2024
*RTX and CYC are both effective followed by RTX at least 500mg q 6 mo for at least 2 years
*PLEX not generally used, but may be effective in preventing ESKD
*Rapid GC tapering may not be suitable for all pts
*Avacopan is… https://t.co/haI19Sgpmu https://t.co/jhjXLwd0Uw
Dr. Rachel Tate uptoTate ( View Tweet)
PJP prophylaxis in GPA. Always a trade off but these things are not created equal. PJP or sepsis are much worse on average than the AEs @anisha_dua @RheumNow #RNL2024 https://t.co/9sECd7fSRk
Richard Conway RichardPAConway ( View Tweet)
Remission maintenance in AAV. First 2 years is clear - fixed dose RTX is superior. After that it is clear that following ANCA is suboptimal, could consider either B-cell return dosing or ongoing fixed dosing @anisha_dua @RheumNow #RNL2024 https://t.co/0Elir88L9U
Richard Conway RichardPAConway ( View Tweet)
Maintenance issues in GPA. Clear messages. 1. RTX is best 2. Fixed 6-monthly RTX best for 1st 2 years. 3. Don't stop RTX at 2 years! @anisha_dua @RheumNow #RNL2024 https://t.co/jS3jWm0CcS
Richard Conway RichardPAConway ( View Tweet)
The answer to "always" is "always" no, correct? PEXIVAS low dose is a great baseline plan, but always adjust in light of the individual patient both upfront and especially if things aren't working out @anisha_dua @RheumNow #RNL2024 https://t.co/RPnpAdB1eG
Richard Conway RichardPAConway ( View Tweet)
Rapid GC taper in ANCA vasculitis
#RNL2024 @RheumNow
@anisha_dua
PEXIVAS - reduced GC is safe, decreased ifns
Retrospective real world - 234 pts. Reduced dose GC+RTX increased death/ESKD HR 2.42. No difference in infections https://t.co/SWIUSyVbWb
Eric Dein ericdeinmd ( View Tweet)
Great talk @anisha_dua re:AAV, solid updates on mgmt decisions
Looking forward to debating this study with @lastwalsh w/@MatsJunek moderating... @TerrierBen any updates on when your RWD study will be published?
@RheumNow https://t.co/ywVaOIp2WJ
Mike Putman EBRheum ( View Tweet)
Contrasing ACR/VF and EULAR GPA guidelines from @anisha_dua @RheumNow #RNL2024 https://t.co/RLJx9fJHGk
Richard Conway RichardPAConway ( View Tweet)
"Real world studies: When people stop being polite and start getting real." Dr @anisha_dua #RNL2024
Comparing Walsh to Nagle in terms of primary outcomes, regimens, pt populations, and plasma exchange.
@RheumNow https://t.co/io8OGnWxdS
Dr. Rachel Tate uptoTate ( View Tweet)
Is there data for PLEX in GPA?
@anisha_dua #RNL2024 @RheumNow
PEXIVAS negative study
But subgroups show decreased dialysis...
But, no improvement in mortality and increased infection risk https://t.co/K9VbcNNsge
Eric Dein ericdeinmd ( View Tweet)
#RNL2024 @RheumNow
@anisha_dua
Throwing the kitchen sink in severe GPA
CYC + RTX combo - sick population (median GFR 9, 47% on HD, 52% DAH, all received PLEX too)
- 85% survival, 69% not ESKD, low rates of relapse (13% at 36 mos)
But, prolonged B cell depletion, aggressive Rx https://t.co/9AZFMQ3o9P
Eric Dein ericdeinmd ( View Tweet)
@anisha_dua reviews differences between EULAR vs ACR Vasculitis guidelines #RNL2024 @RheumNow https://t.co/1aIbnX5KBI
TheDaoIndex KDAO2011 ( View Tweet)
@anisha_dua reviews GPA management in 2024. Here are your ACR/VF 2021 and EULAR 2022 guideline updates. Review these regimen options for your patients. #RNL2024 @RheumNow https://t.co/SvQoe0YKKV
Dr. Rachel Tate uptoTate ( View Tweet)
Clinical Pearl!
@DrCassySims currently treats with ASA 81mg po daily during vasculitis pregnancies at 12 weeks for preeclampsia ppx.
She notes there is some data/use of 162mg po daily in Europe which may change the way we practice in the future.
#RNL2024 @RheumNow
Dr. Rachel Tate uptoTate ( View Tweet)
Pregnancy in vasculitis checklist:
- goals and timeline
- disease activity in 12 mos
- is there end organ damage?
- Review Rx
- h/o clots/miscarriages, APLS?
- Check Ro/La
- Role for ASA?
- Refer to MFM
Catherine Sims #RNL2024 @RheumNow
Eric Dein ericdeinmd ( View Tweet)
How do vasculitis pts do during pregnancy?
Variable due to different diagnoses of flares
Gatto 2012: TA 3% flare, GPA 45% flare
Fredi 2015: 35% flare
Nguyen 2021: LVV 25% flare, 36% SVV
-Catherine Sims
#RNL2024 @RheumNow
Eric Dein ericdeinmd ( View Tweet)