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

Factors associated with Anti Drug Ab against TNFi over 2-y in axSpA pts are: ⭐️ 🔼 Disease activity ⭐️Development of adverse events ⭐️Treatment discontinuation Abst #0936 #ACR21 @RheumNow

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

Dr Naovarat reports on 18 year outcomes of HIV and rheumatic disease. 16 patients treated with TNFi, including 2 who switched to tocilizumab and ustekinumab. No major infections. Rising viral load in 1 led to discontinue. Abstr#0965 #ACR21 @RheumNow https://t.co/jcGPaURKmb

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