PsA Switch or Cycle, the Eternal Question Save
Dr. Aurelie Najm reports on abstracts POS0278 and POS0266 presented at Eular 2024 in Vienna, Austria.
Transcription
Hi everyone. This is Orelimaj live from Vienna Conference Center. After three days of conference right now, I can confidently say that I have learned a lot as always. A couple of abstracts I want to discuss with you and it comes down to the eternal question we ask ourselves in clinics which is in PSA after a first failure of a TNF inhibitor, what action? Do you go for another TNF inhibitor?
EULAR and GRAPA recommendations have not formally stated whether it should be one or the other, and so the first poster that tried to answer that question is poster two seventy eight and so what it does is that it looks at a cohort of 400 plus PSA patients that were and it's interesting it's from The Netherlands and they have this historical cohort where there was only TNF inhibitors available that was before IL-seventeen. So obviously they had to kind of cycle yeah and then they have this was a cohort of about a few more patients that they did a swap from TNF to AL17, and they look at the three years retention rate as a surrogate for efficacy, as well as one year disease activity. So what they find, I found it quite interesting, is that when they do adjust for discontinuation reason, which I think is a very thing to adjust for and a lot of other cohorts haven't done that, they don't see any difference in retention, which does make sense in some ways, and also they don't see any difference in that CRP in the two swapping versus cycling groups at one year. One thing they did see though is that when they separate groups between male and females, they saw that males actually that were cycling rather than swapping for a different mechanism of action did have a worse prognosis.
In fact, they had an odd ratio of failure of the drug of 1.67, but this was not found in females, which in itself is also an interesting finding that requires further studies. And then the other poster was two sixty six and this one finds somehow different results. It was the BRAF cohort, three forty plus patients with PSA, a group that swapped, a group that cycled again, and then they did find a better outcome in people that were swapping, which is also interesting. But one thing to note there is that they did not adjust for reason for discontinuation and I don't think, I mean they don't describe having adjusted on a lot of data actually, so I would be a bit more wary about these data. But I think what we need actually is probably a trial so that we know exactly what to do and I'd be interested to hear what you do in your practice.
But for now I will go and thank you for this, your attention in this and follow me on Twitter AurelieRemo and follow RheumNow.
EULAR and GRAPA recommendations have not formally stated whether it should be one or the other, and so the first poster that tried to answer that question is poster two seventy eight and so what it does is that it looks at a cohort of 400 plus PSA patients that were and it's interesting it's from The Netherlands and they have this historical cohort where there was only TNF inhibitors available that was before IL-seventeen. So obviously they had to kind of cycle yeah and then they have this was a cohort of about a few more patients that they did a swap from TNF to AL17, and they look at the three years retention rate as a surrogate for efficacy, as well as one year disease activity. So what they find, I found it quite interesting, is that when they do adjust for discontinuation reason, which I think is a very thing to adjust for and a lot of other cohorts haven't done that, they don't see any difference in retention, which does make sense in some ways, and also they don't see any difference in that CRP in the two swapping versus cycling groups at one year. One thing they did see though is that when they separate groups between male and females, they saw that males actually that were cycling rather than swapping for a different mechanism of action did have a worse prognosis.
In fact, they had an odd ratio of failure of the drug of 1.67, but this was not found in females, which in itself is also an interesting finding that requires further studies. And then the other poster was two sixty six and this one finds somehow different results. It was the BRAF cohort, three forty plus patients with PSA, a group that swapped, a group that cycled again, and then they did find a better outcome in people that were swapping, which is also interesting. But one thing to note there is that they did not adjust for reason for discontinuation and I don't think, I mean they don't describe having adjusted on a lot of data actually, so I would be a bit more wary about these data. But I think what we need actually is probably a trial so that we know exactly what to do and I'd be interested to hear what you do in your practice.
But for now I will go and thank you for this, your attention in this and follow me on Twitter AurelieRemo and follow RheumNow.
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