#ACR21 Abst#0588. TNF vs non-TNFi in obese RA pts ⭐️TNFi use ⬆️ disease activity vs ABA in obese pts ⭐️TNFi use ⬆️ activity vs TCZ in non-obese pts ⭐️No diff w RTX, Tofa ▶️Further research needed: Wt-based dosing? SC vs IV? https://t.co/K8WycPTgxW @Rheumnow #ACRBest

• https://bit.ly/3H1GMDI

ORAL Surveillance MACE conclusions: So this is fair: tofacitinib acts as a CV risk factor, there are many others, we need to address CV risk in RA pts. Nevertheless, in terms of MI risk, tofa vs TNFi, if I had one CV risk factor, I know what I'd do. #ACR21 ABST0958 @RheumNow https://t.co/4Z79XtTzl9

SELECT-AXIS 1: UPA 15 mg QD consistently efficacious over 2 years for ASAS40. Low radiographic progression rates in AS pts. No new safety findings were observed. Abs 0924 #ACR21 #RheumNow @RheumNow https://t.co/CWvH1OPGyR https://t.co/uC67fJZDCE

• Efficacy and Safety of Upadacitinib in Patients with Active Ankylosing Spondyli…

Abst0509 #ACR21 @RheumNow study of plasma concentrations of Deucravacitinib show high functional selectivity for TYK2 while Tofa, Upa & Bari inhibit JAK1/2/3 to varying degrees show no meaningful inhibition of TYK2. Distinct class of kinase inhibitor as compared to JAKs

With Deucravacitinib, a TYK2 inhibitor vs placebo, PsAID-12 and PsAID-9 scores were significantly improved versus baseline at Week 16 and other PROs showing a clear improvement in PsA-related impact @RheumNow #ACR21 Abst#0750 https://t.co/JbeSE2dO94 https://t.co/pH79dXCYSs

• Effect of Deucravacitinib on the Psoriatic Arthritis Impact of Disease Question…

Let's look at MI first. Well, the numbers don't look great for tofa here. fatal MI very small numbers non-fatal MI - well that doesn't look good (do we have combined both tofa doses vs TNFi?) HR > 2 seems less than ideal - this would represent a substantial RF #ACR21 @RheumNow https://t.co/5HSXFrMJCu

ORAL Surveillance: MACE events higher in TOFA vs TNFi. Independent risk factors: smoking, aspirin use, age ≥ 65 yrs, and male sex; TOFA vs TNFi tx in these pts assoc'd w/ numerically higher MACE incidence. Plenary Abs 0958 #ACR21 #ACRbest @RheumNow https://t.co/44af1KujqP

• Risk Factors for Major Adverse Cardiovascular Events in Patients Aged ≥ 50 Year…

Tofacitinib vs TNF inhibitors in #RA patients +50yrs with >1 CV risk factor; the data from ORAL Surveillance that we have all been waiting for! #ACR21 Risk of MACE related largely to baseline CV risk https://t.co/SpuKTtP8ql

ORAL-Surveillance, an open label Phase 3b/4 RCT of tofacitinib (JAKi) vs TNFi in RA Numerical elevations in MACE and MI, highest among pts w/hx of CAD or high 10-year risk for MACE I have been considering baseline CVD / VTE / CA risk when prescribing these since this broke https://t.co/8DAx8IgnZM

ORAL surveillance TOFA vs. TNFi: in patients with > 50yo > 1 CV risk MTX IR -# ⬆️ in MACE and MI (not stroke) -MACE risk factors on TOFA smoking, >65 male gender -# ⬆️ MACE in its w/ any of these RF What are you going to tell your patients? #Abtr0958 #ACR21 #ACRBest @RheumNow https://t.co/81kVTH63bb

MACE risk Tofa vs TNFi ORAL surveillance: age 50+ w/1 additional CV risk, MTX-IR 👉higher # MACE, MI in Tofa 5 or 10 mg bid (no increase in stroke) 👉risks for MACE w/tofa: tobacco, ASA, age 65+, male sex 👉counsel high risk pts (?avoid use) Abst#0958 #Plenary #ACR21 @rheumnow https://t.co/tg35cts9tw

Oral Surveillance outcomes in a nutshell Tofacitinib two doses vs TNFi event driven trial more AEs of interest in Tofa groups MACE Malignancy SIE in older groups VTE esp #tofacitinib 10 mg BID @RheumNow #ACR21 #ACRBest abst#0958 https://t.co/j39g7yVVFB

1133 MACE events in Oral Surveillance study - Tofa use in high risk pts had more MACE events than TNFi use. Abstr# 0958 #ACR21 Problems with the gimmish are: - Older patients, w/ Hi CV Risk - 50% prednisone use - Use of TNFi as comparator (effective at lowering CV risk) https://t.co/lzIyhgzvRe

⭐️IR for MACE, MI, non-fatal MI numerically ⬆️ in Tofa vs. TNFi ⭐️HR for MACE/MI/stroke >1 for Tofa vs. TNFi ⭐️Risk factors: Smoking, ASA use, Age>65, men ⭐️Pts without risk factors, IR for MACE were similar Abs#958 #ACR21 @RheumNow #ACRBest https://t.co/xA3aGu5Sqi https://t.co/VnPHBhrmdx

• Risk Factors for Major Adverse Cardiovascular Events in Patients Aged ≥ 50 Year…

okay, so let's look at the #ACR21 plenary as we go so a reminder - FDA-mandated phase 3b/4 safety endpoint study specifically looking at patients >50yo with at least one other CV risk factor today we're looking at MACE: that's CV death (excl PE), MI, stroke ABST0958 @RheumNow https://t.co/9U8Sahb9Q7