#ACRbest Abstracts – Day 2 Save

Jack Cush, MD

Nov 13, 2023 8:00 pm

Our reporters have been prolific in finding the hot abstracts, those that were most attended or those that are getting the most buzz on social media. Here are RheumNows #ACRbest abstract reports from Monday, November 13, 2023 at #ACR23.

THE GREAT DEBATE

Great Debate on the use of biologics in treatment of Giant Cell Arteritis and Polymyalgia Rheumatica!

Let's begin with Dr. Robert Spiera on why we should NOT use IL-6i
No evidence of disease modifying
Lose biomarker activity
Cost@RheumNow #ACR23 #ACRbest pic.twitter.com/XCT02wYb2s
— Robert B Chao, MD (@doctorRBC) November 13, 2023

#ACR23 #Debate Dr Spiera says NO need to up front use #glucocorticoid #sparing drugs in PMR - maybe only if flaring. Esp in PMR vs #GCA where maybe bDMARD in GCA in some Pts (my opinion) but for sure if failing #ACRbest #ACR23 @RheumNow @ACRheum pic.twitter.com/Rt7rGZv3fW
— Janet Pope (@Janetbirdope) November 13, 2023

#GCA Rx #bDMARD is established to #steroid spare and reduce relapses. #Tocilizumab #GiACTA Dr Seo said ‘biologics work and steroids are bad!’ ⁦@ACRheum⁩ ⁦@RheumNow⁩ #ACR23 #ACRbest pic.twitter.com/JmSE1KKlf5
— Janet Pope (@Janetbirdope) November 13, 2023

SGLPT2 INHIBITORS IN SLE

#ACRBest https://t.co/aOxNVt0rNR
— Aurelie Najm (@AurelieRheumo) November 13, 2023

In their cohort, Dr. Jorge reports that SLE pts who used SGLT2i had⬇️risk of MACE(HR 0.69 [95% CI 0.48-0.99]) & renal progression(HR 0.71 [95% CI 0.51-0.98]) vs DPP4 use
Risk of MACE also⬇️in LN subgrp
🧐💊A potential role of SGLT2i for SLE/LN? #ACR23 ABST1579 @RheumNow #ACRbest pic.twitter.com/Dod8DqRvLo
— sheila (@RHEUMarampa) November 13, 2023

SMART STUDY OF MTX

Abst#1583 SMART study: Split dose qwk MTX (10 mg QAM, 15 mg QPM) may have better efficacy compared to 25 mg single dose qwk MTX. RCT 253 RA patients: split dose had better DAS score, less likely to add other DMARDS, but slight⬆️in LFTs. #Plenary #ACR23 @rheumnow #ACRbest
— TheDaoIndex (@KDAO2011) November 13, 2023

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 pic.twitter.com/g7s4EUHeCW
— Mike Putman (@EBRheum) November 13, 2023

Split dose oral MTX (15/10mg) versus single dose (25mg) in RA RCT 250pts

EULAR good resp
16wks 22 vs 10% (sig)
24wks 37 vs 28% (ns)

50% more addition of 2nd csDMARD in single dose #ACRBest @RheumNow #ACR23
ABST1583

For more thoughts, have a read https://t.co/urA6X4rY0D 👇🏼
— Aurelie Najm (@AurelieRheumo) November 13, 2023

TMP/SMX PROPHYLAXIS

Trimethoprim sulfamethoxazole (TMP-SMX) negatively associated with serious infections. Rates for adverse events possibly attributable to TMP-SMX per 100 person-years were 29.6 during and 13.4 post exposure. Mendel A, Abst#1584 #ACR23 #ACRBest @RheumNow https://t.co/hHY2bZXrkS pic.twitter.com/2YMoCi1zrx
— Dr. Antoni Chan (@synovialjoints) November 14, 2023

RA-ILD & TNF INHIBITORS

Abst#1583 SMART study: Split dose qwk MTX (10 mg QAM, 15 mg QPM) may have better efficacy compared to 25 mg single dose qwk MTX. RCT 253 RA patients: split dose had better DAS score, less likely to add other DMARDS, but slight⬆️in LFTs. #Plenary #ACR23 @rheumnow #ACRbest
— TheDaoIndex (@KDAO2011) November 13, 2023

#ACRBest https://t.co/aOxNVt0rNR
— Aurelie Najm (@AurelieRheumo) November 13, 2023

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 pic.twitter.com/TIDzMLOfs4
— Mike Putman (@EBRheum) November 13, 2023

CANCER RESEARCH

Suarez-Almazor et al. TNFi in early breast cancer do not impact overall survival, HR=0.75 (0.41-1.37), HR=0.86 (0.55-1.34). Better cancer specific survival HR=0.29 ( 0.09-0.98)! Abstr#1675 #ACR23 #ACRbest @RheumNow https://t.co/qS5W7WehiN
— Richard Conway (@RichardPAConway) November 14, 2023

POTPOURRI

Michaud et al. RA patients with long COVID had more fibromyalgia pre-COVID (41% vs 13%), higher rates of pain, depression, and worse PROs pre-COVID. Authors suggest long COVID may partially reflect pre-existing illness Abstr#1629 #ACR23 #ACRbest @RheumNow https://t.co/mrcGWrSD6c pic.twitter.com/YiGCbvBDtn
— Richard Conway (@RichardPAConway) November 13, 2023

Biologics are working for ankylosing spondylitis, even in reducing cardiovascular mortality!
Large retrospective study of over 4k pts over 20 years showed decrease in CV mortality from 34% in 1999 to 21% in 2020@RheumNow #ACR23 Abs#1399#ACRbest pic.twitter.com/wKCIXHza0v
— Robert B Chao, MD (@doctorRBC) November 13, 2023

ABS0164 @ #ACR23

Is a virtual MSK test consistent & comparable to in-person assessments w/ regard to dz activity in f/u of RA pts?

YES!
Some variability in # of swollen joints but approach shown below had good reliability & acceptable lvl of agreement@RheumNow #ACRBEST pic.twitter.com/yxpPb2Br4n
— Meral K. El Ramahi, MD (@MeralElRamahiMD) November 13, 2023

#ClinicalPearl or #pathology pearl? Using synovial #biopsies to guide therapy in #RA #RCTs is a reality. But likely #fibrotic #phenotype won’t respond and #lympho_myeloid has more RA damage. #ACR23 session 13M140 #Precision #medicine #ACRbest ⁦@ACRheum⁩ ⁦@RheumNow⁩ pic.twitter.com/DmI9dNpu8w
— Janet Pope (@Janetbirdope) November 13, 2023