Drug Safety
ORAL surveillance was a post-authorisation safety study of tofacitinib 5mg and 10mg versus TNF inhibitors, focusing on rates of adverse events, including MACE. A higher incidence of MACE was observed with the use of tofacitinib. Statins are recommended in patients with a history of atherosclerotic disease or 10 year predicted risk of MACE. But, how many patients with rheumatoid arthritis, at risk of MACE, are actually taking a statin?
David Liew drdavidliew
10 months 3 weeks ago
Instead of just JAKi, why don't we look at all our RA meds and MACE risk
FAERS data & reporting odds ratios here: all the caveats of voluntary reporting, so don't put too much weight, but...
prednisone. Don't forget pred is really not great for MACE!
#ACR24 ABST1981 @RheumNow https://t.co/L9SlPZF2Jd
David Liew drdavidliew
10 months 3 weeks ago
Always looking for cancer/CV signals from JAKi in big observational datasets w extensive JAKi use nationwide 🇯🇵 claims data RA pts n=52k (JAKi n=4.3k) Cancer with JAKi vs TNFi: aHR 2.2 (esp lung, lymphoma) This is a problem. Watch these data. #ACR24 ABST1336 @RheumNow #ACRBest https://t.co/vsnT46De6T
David Liew drdavidliew
10 months 3 weeks ago
ANA neg, but ENA pos
should we care about that result?
PPV 5.5% here
(similar to 6% prev @EricFMorand: https://t.co/Hyaued3rw2)
and how many really needed the serology? Anxiety?
Surely pos ENA w neg ANA might be more hassle than help. So what to do?⬇️
#ACR24 ABST1930 @RheumNow https://t.co/rE7RmgOGey
David Liew drdavidliew
10 months 3 weeks ago
Should you worry about giving TNFi to RA pts after a cancer diagnosis?
Medicare data with colorectal, lung, prostate Ca:
TNFi pts survival no worse (numerically better) than csDMARDs
Cancer pts deserve good RA treatment!
#ACR24 ABST0202 Suarez-Almazor @MDAndersonNews @RheumNow https://t.co/w58MNqRt1T
David Liew drdavidliew
10 months 3 weeks ago
Upadacitinib in Behcet's disease - would be very much welcomed, and this open label 8 patient pilot from China is encouraging.
We saw similar data for tofacitinib before @ARD_BMJ: https://t.co/YlAQVXpnTY
JAKi (?generic) could be a fantastic option!
#ACR24 ABST2515 @RheumNow https://t.co/65friNLUOK
David Liew drdavidliew
10 months 3 weeks ago
Steroids in checkpoint inhibitor rheumatic irAEs need to be approached with caution.
Persistent higher doses earlier on might dampen ICI response.
@HSpecialSurgery ICI-IA (inflamm arthritis) cohort
big diff in survival based on early steroid exposure
#ACR24 ABST1989 @RheumNow https://t.co/3WAZ3ZLbFw
David Liew drdavidliew
10 months 3 weeks ago
Rheumatic irAEs can get on the CAR-T bandwagon, too!
CAR-T can invoke new rheumatological issues (not just cytokine release) - see @DrGomezPuerta's experience.
Infrequent, but if CAR-T in general becomes common, yet another job for us to attend to...
#ACR24 ABST2004 @RheumNow https://t.co/xBSlhUdkNr
David Liew drdavidliew
10 months 3 weeks ago
Now that nipocalimab is approved for Sjogren's Disease, what about vaccination response whilst on this FcRn inhibitor (inherently lowers IgG)?
Actually, not bad: takes a little longer to get there, but reassuring!
(always fun to get to know a new med)
#ACR24 ABST1988 @RheumNow https://t.co/IYqIGo5xVP
David Liew drdavidliew
10 months 3 weeks ago
Here's a meta-analysis of MACE/malignancy in JAKi vs TNFi in observational cohort studies.
All the epidemiological challenges here aside, it's a good reminder that with ORAL Surveillance it's *cardiovascular risk enriched pts* we're concerned about.
#ACR24 ABST2264 @RheumNow https://t.co/vIXlrI3V2d
Here’s a collection of some of the best abstracts presented on day 2 of ACR 2024 as selected by the RheumNow faculty.
Plenary sessions began the day, followed by thousands on the abstract floor. Here are a few of my favorite presentations from day 2 at ACR 2024.
Brian Jaros, MD Dr_Brian_MD
10 months 3 weeks ago
We saw evidence for JAK use in GCA this conference... what about IL-1 inhibition?
Double-blind RCT: Anakinra vs. PBO w/ similar GC taper in GCA pt
NO difference in relapse rate at 26, 52 wks despite addition of Anakinra
@RheumNow #ACR24 Abst1699 https://t.co/gUb0gGJjTG
Mike Putman EBRheum
10 months 3 weeks ago
Super helpful results from COVER study, holding JAK or IL17 for COVID boosters Antibody titers went up regardless of holding Holding caused flares (14-25% increase!) Pretty clear message; continue JAK / IL17 #ACR24 @RheumNow Abstr#1718 #ACRbest https://t.co/Mf89dWrRWz
Brian Jaros, MD Dr_Brian_MD
10 months 3 weeks ago
Would be helpful for us (and pts) to better understand rimmunotherapy agent specific risk on subsequent GCA/PMR
AFTRER propensity matching of >7k pt on combo nivolumab/ipilimumab compared to pembrolizumab:
- PMR RR 3.8x N/I vs. P
- no diff in GCA risk
@RheumNow #ACR24 https://t.co/IF4Gh7Cumd
Poster Hall