TNF inhibitor

Robert B Chao, MD doctorRBC
2 years 10 months ago
Interesting data on TNFi use in ankylosing spondylitis.
Early TNFi use, compared to no TNFi associated with higher CVD, stroke and MACE.
@rheum_cat any thought on why? and why there were so many non-TNFi users (15k vs. 2k)?
Abs#0415 @RheumNow #ACR22 https://t.co/PVkt8gPHFW


Dr. Rachel Tate uptoTate
2 years 10 months ago
@rheum_cat et al Abs 0415 TNFi initiation early in AS dz course (compared to no initiation) showed higher risk of incident CVD, stroke & MACE individually! Residual confounding by indication cannot be excluded. Were TNFi tx pts sicker? #ACR22 @RheumNow https://t.co/ERoDhS2yOY https://t.co/8tto5AIUSP


Robert B Chao, MD doctorRBC
2 years 10 months ago
Another study showing treatment withdrawal does not work.
Golimumab withdrawal in nr-axSpA is inferior to continued treatment or tapered treatment, leading to more disease flares.
Abs#0545 @RheumNow #ACR22 https://t.co/CBRnVdxXVo


Robert B Chao, MD doctorRBC
2 years 10 months ago
2022 ASAS-EULAR Recommendations of AxSpA management
1) NSAIDs still first line
2) Analgesics/opioids contraindicated
3) TNFi, IL-17i first line bDMARDs, followed by JAKinibs
4) Tapering but not discontinuation of bDMARDs in sustained remission
Abs#0542 @RheumNow #ACR22 https://t.co/ffaN2fMc3v


Richard Conway RichardPAConway
2 years 10 months ago
Liew @rheum_cat et al. No evidence of cardioprotective effect of early initiation of TNFi in AxSpA. In fact seemed to be associated higher risk! CVD (HR 1.17), stroke (HR 1.24), and MACE (HR 1.22) @rheumnow #ACR22 Abstr#0415 https://t.co/a9lpxQuMB9 https://t.co/GdGfYxcAH6


Dr. Antoni Chan synovialjoints
2 years 10 months ago
Therapies for AS and nr-AxSpA are coming together. Both AS and nr-AxSpA present with similar burden of disease. TNFi, IL-17i and JAKi now approved for use in nr-AxSpA.
Jose U Scher, SpA Review @RheumNow #ACR22 https://t.co/vcHcd7OyAU


Richard Conway RichardPAConway
2 years 10 months ago
England et al. Influence of FVC on choice of b/tsDMARD in RA-ILD. FVC predicts hospitalisation and mortality. However, it did not appear to influence choice of b/tsDMARD. Overall 67% of RA-ILD patients initiated TNFi, weird! @rheumnow #ACR22 Abstr#245 https://t.co/swuNHv96WD https://t.co/vy5FUPnNjo

The management of RA patients with a history of cancer continues to be an area of concern. General recommendations are to treat patients with a history of solid organ cancer as no different to any other RA patient. Recently, the ORAL-Surveillance study demonstrated evidence of a greater risk of cancer with tofacitinib than with TNF inhibitors. In this setting, two posters both reassure and raise a new cause for concern.
A new treatment for AxSpA that has come on the scene are JAK inhibitors. In clinic, considerations for JAKi use are body mass index, smoking status, prior use of biologics and patients with high inflammatory states such as high CRP and inflammatory change on MRI scan of the spine and sacroiliac joints. There are further studies at #ACR22 which help answer these questions.
As we approach ACR22, there are many things to be excited about, especially with the reintroduction of in-person attendance. My attention this year is in research being presented in these three areas: ankylosing spondylitis; lupus management and treatment; and, subclinical RA.
New research being presented this week at ACR Convergence 2022, demonstrated that polyarticular juvenile idiopathic arthritis patients were more likely to achieve clinical remission with a combination of conventional and biologic DMARDs compared with other consensus treatment plans by the Childhood Arthritis and Rheumatology Research Alliance (CARRA).