Obs study, bDMARDs & malignancy TNFi w/lower risk than ABA/RTX/IL6i & numerically lower than JAKs I'm a little skeptical... KM curves diverged w/~45 days, seems implausible? Agree w/first author, possible channeling bias @RheumNow #ACR23 Abstr 1678 https://t.co/1uL3j6kTSj

Sendaydiego et al. Comparative cancer safety b/tsDMARDs. 37,026 patient database cohort study. Compared to TNFi, RTX HR 2.2 (1.5, 3.3) ABA HR 1.7 (1.3-2.4), JAKi HR 1.3 (0.9-1.9). Abstr#1678 #ACR23 @RheumNow https://t.co/bTNtaNJrln https://t.co/qQBM2F2q8N

Ritux (OR 2.2), ABA (OR 1.3), JAKi (OR 1.3) significantly increase risk of cancer vs. TNFi Cohort of 37000+ RA pts starting bio/tsDMARDs (379 incident cancers) True biologic effect or confounding by indication in a generally more comorbid population? @RheumNow #ACR23 ABST1678 https://t.co/suj6mVBEC0

2 RA cohorts w/Breast Cancer 17% TNFi within 1yr after surgery No diff in overall survival at 5 yr w/ TNFi or csDMARD Trend towards better BC specific survival w/ TNFi vs. csDMARD only Worst survival for GC>7.5mg/day Only 2 yrs follow up @RheumNow #ACR23 ABST1675 https://t.co/ekKlJ2dP5i

Does TNFi use in pts with RA and early breast cancer affect survival? TNFi did not affect overall survival or breast cancer specific survival compared to cDMARDs Steroids did increase mortality @RheumNow #ACR23 Abs#1675

No significant difference in overall survival in early stage breast cancer (BC) patients treated with TNFi (alone -/+ cDMARDs, in 1st year of BC) and cDMARDs in RA. Those on glucocorticoids had worse survival. Suarez-Almazor M, Abst#1675 #ACR23 @RheumNow https://t.co/lnZx3OpuN5

There was a lower hazard ratio for incident cancer with exposure to TNFi compared to non-TNFi (RTX and ABA) and JAKi. Limits: potential for residual confounding by indication and small number of outcomes per drug class, Xavier S, Abst#1678 #ACR23 @RheumNow https://t.co/vJpFwl6Ivj

SMART study in RA, splitting MTX Split dosing better at wk 16 but ~similar at wk 24 Caveat: wonky design from wk16-wk24 makes it hard to interpret? Surprsingly, adverse events ~similar but smallish sample Mostly supports my practice of splitting? @RheumNow #ACR23 #ACRBest https://t.co/g7s4EUHeCW

Large VA study of >1k RA-ILD pts No difference in risk of respiratory hospitalization or death in RA-ILD pts using TNFi vs. nonTNFi/JAKi Data does not support avoiding TNFi in RA-ILD @RheumNow #ACR23 Abs#1582 https://t.co/LTNLXEIAPo

Important plenary session, RA-ILD outcomes in VA cohort study No difference in death/hospitalization for TNF vs non-TNF treated patients. Jives w/my priors; I do NOT avoid TNF in RA-ILD Encouraging if you (like me) prefer RA-active tx for RA-ILD 😉😆 @RheumNow #ACR23 #ACRBest https://t.co/TIDzMLOfs4

Glucocorticoids-free zone in SLE? For over 70 years, glucocorticoids, (GC) have been a part of standard therapy in SLE. They are classically used to not only induce remission or treat an acute flare, but also as maintenance therapy. #ACR23 https://t.co/sfRhNj6OpZ https://t.co/k6VoG5lKO7

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