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

Abst#0946 shows a distinct lipid profile in RA vs PsA synovium + synovial fluid. Sphingomyelins & phosphatidyl-cholines/ethanolamines had the greatest separation power to classify RA + PsA samples. These lipid markers may have clinical utility if validated. #ACR21 @Rheumnow https://t.co/ktKRypTtlE

Outcomes of COVID-19 in Patients with Rheumatoid Arthritis. Dr. Akhil Sood ( @AkhilSoodMD) shares the studies presented #ACR21. https://t.co/yrs8N8XSiS https://t.co/EKHuTS5aDr

• https://bit.ly/2YmsXym

VITAL RCT of Omega-3 and Vit D in preventing autoimmune diseases in 25,871 individuals. They both work! Reducing incident autoimmune disease by 25-30%. This is game-changing! Abstr#0957 #ACR21 @RheumNow #ACRBest https://t.co/BaeZDTTnQf

#ACR21 Abst#0836. TCZ switch from IV▶️SC in RA ⭐️11/37 ineffective on SC (30%) ⭐️TCZ IV >8mg/kg, no MTX, h/o ABA failure ass w/ risk of flare on SQ switch 🔥Very relevant w shortages, want more data re: confounders (adherence, disease control) https://t.co/E9pD4SrXqz @Rheumnow

• https://bit.ly/3keDrHK

#ACR21 Abs#0834: CorEvitas Registry TNFi vs IL-6 in RA ⭐️IL6 pts older, longer h/o RA, higher CDAI, more prior Rx ▶️ No difference in outcomes bw IL6 and TNFi (monotherapy or combo w MTX). ▶️1/3 of pts achieved LDA Limits: real-world, unblinded https://t.co/AJtzeMuj1T @Rheumnow

• https://bit.ly/3qdAU4s

Dr Jin @SeoyoungCKim population-based study on predictors of switching after 1st line TNFi use. 22% switch, most to 2nd TNFi.👩, prior steroid use predicted change, other autoimmune disease and vit D use negative predictors. Abstr#579 #ACR21 @RheumNow https://t.co/YpZ5rGBiod

Jorge Plutzky, cardiologist perspective on RA at #ACR21 ⭐️CANTOS: Canakinumab for MACE shows ⬇️ inflammation, no change in LDL. Improvement in MACE events ▶️Plutzky: "Proof of concept study" @Rheumnow https://t.co/Xi9ZHxMtmu

Another benefit of DMARD use in RA. Dr Sood reports lower risk of long term opioid use. Very important given the harm of opioids Abstr#587 #ACR21 @RheumNow https://t.co/d1Dharf5jZ

We need to control not only inflammation but also lipids levels in our patients w/ IA! Dr Plutzky brilliantly talking us through CV risk and RA showing data on how poor LDL control and coronary microvascular dysfunction lead to worse long term CV outcomes. @RheumNow #ACR21 https://t.co/o6GWHDai5z