Girolami et al. VA study. Safety of DMARDs in RA following melanoma. 644 patients. 3 year all cause mortality. No significant difference, but graph sure looks like b/tsDMARDs are better. No melanoma specific mortality/recurrence data however. @RheumNow #ACR25 Abstr#2237 #ACRBest https://t.co/IN4LDkioT7

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HCQ weight-based dosing: out HCQ whole blood monitoring: in Whole blood levels more precisely balance risks of SLE flare (under-dosing) vs. toxicitiy (over-dosing) Many pt on <5 mg/kg had supra-therapeutic blood levels with risk for toxicity @RheumNow #ACR25 #ACRBest Abst 1722 https://t.co/qIbACxAW39

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Passive transfer of Ab can occur w #IVIg #Ab can occur from IVIg passive transfer incl HepB IVIg - if pt has #cryoglobulins 👇 Can precipitate severe #cryo flare #ClinicalPearl Secrets & Pearls session #ACR25 @RheumNow @ACRheum https://t.co/tTaSuVy1yQ

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Pooled data fr diff SLE cohorts by Dr SGarg et al were evaluated to determine an upper threshold tx range of HCQ 750-1150 ng/mL: safe & effective HCQ levels >1150ng/mL-supratx, no added tx benefit CKD st >/=3: 2x ⬆️odds of toxic hcq levels #ACR25 @RheumNow Abs1722 #ACRBest https://t.co/RFx1VO0bov

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3rd plenary session! #1722 Defining safe HCQ levels in SLE: whole-blood 750-1150ng/mL= therapeutic range; >1150ng/mL ➡️ ~2× toxicity risk; <750ng/mL ➡️ higher flare risk CKD ≥3 increases odds of supratherapeutic levels New era of precision monitoring in SLE? @RheumNow #ACR25

Plenary 3, HCQ blood levels in SLE HCQ level > 1150: 1.9x risk of HCQ toxicity HCQ level < 750: 1.4x risk of active SLE HCQ dose < 5mg/kg: 1.9x risk active SLE My take home? Blindly reducing dose to <5mg/kg is BAD; use levels instead! @RheumNow #ACRBest #ACR25 Abstr1722 https://t.co/UCBPAKAyon

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#ACR25 Please find my video and take on Abstr#0803. Should we use Belimumab before- or after a trial of concentional immunosuppressant in #SLE? @RheumNow https://t.co/ExIvrdJXw5 https://t.co/AVb5ohWwXZ

• Belimumab Before or After Immunosuppressant | RheumNow
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#ACR25 Abstr#0855 Five extra patients were added to complete IMPACT Open Label Phase 2 trial of add-on Certolizumab in APS women + LAC+ve. Results stood: primary endpoint was met (adverse pregnancy outcome=19.6%; lower than 20% expected). Significant enough to adopt @RheumNow https://t.co/zhFVGYXiaU

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So who with inflamm arthralgias might benefit from abatacept, in terms of delaying RA onset? ALTO study (APIPPRA continuation) 1y abatacept then follow If autoAb x5 (RF, ACPA IgG, IgA, anti-CarP, AAPA): sustained delay of RA If not: benefit only on Rx #ACR25 ABST1678 @RheumNow https://t.co/3Pc5ZLzVf6

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Early TNFi treatment leads to -Less D2T at 5 yrs -More sustained remission at 10yrs -Less bDMARD escalation at 5yrs -More DMARD free remission at 5yrs and 10 yrs -20% reduction annual healths costs -11 mo delay in ttmt escalation Safety data were not presented #ACR25 https://t.co/jPMGUGPtqP

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