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Hello everyone, I'm Mike Putman reporting from ACR twenty twenty four. Today I want to tell you about abstract five zero one which reported the results of one of the results of the jackpot study. I'm very excited to be interviewing Doctor. Kim Lauper from Geneva for that. So Doctor.

Lauper, welcome. And I'd just like to start by asking you, so what did you do here with the Jackpot study? What was it all about?

So Jackpot is a collaboration of register that we started because we wanted to look at safety and effectiveness of Jackinmeto de Goodwort. So we have up until 21 registered that work together to answer research questions.

I think it's a fascinating topic. In the wake of the oral surveillance study, I think we've all been very concerned about JAK safety. Also, it's just interesting comparing DMARS. There's not a lot of comparative effectiveness research. One of the things I have always heard about and wondered about is whether or not JAK inhibitors work faster than TNF inhibitors.

So that kind of piqued my interest in this abstract. Why don't you tell us about what you studied here and what you found?

So yes, so the idea was really comparing most of the second line treatment we have in RA. So we wanted to compare JAK inhibitors, TNF inhibitors, IL-six inhibitors, and abataceps, and see if there was one of this treatment that was acting faster. And for this, we collected data from 12 of the registers of Jackpot that had data on three or six months after starting the treatment. So what we saw is that all the treatment really act really fast in the first two months, then they act a bit slowlier, and in terms of CDI, pain and HAC. And then we compare them adjusting, because of course it's an observational, observational data so there were some counters.

After adjusting, what we saw is that Jackie and TNF inhibitor were still faster in terms of CDI, HACN pain than the other treatment which was surprising for us.

Yeah, I thought that was surprising for me as well. I would have expected JAKs to be faster based on what I knew already, but the curves on your poster really looked superimposed. There was no real difference between them. So quite an interesting finding. Were there anything else that you gleaned from your data that you thought would be clinically relevant for folks?

So thought abatacept was a bit slowier than the other one, but what I can say abatacept, we really have not a lot of patients that were really in early RA. So have we seen that abatacept maybe works better in early RA? We can't say anything about that in our data.

That makes sense. I always like a measured conclusion. Well, so I think this is a very interesting study. It definitely will at least impact the way I see starting DMARDs. I my preference has been trending towards TNFs as first line, especially given some of the safety data.

Final question for you, is that your practice as well or how did this change your practice?

Yeah, so I'm really more comfortable starting with TNF inhibitors because I see that acts really faster and that's then going to be my practice.

Alright, I

love it. Well thank you so much for joining me. Thanks so much for following all of our content on RheumNow. You can follow me at EBRoom and Doctor. Lauper, was your Twitter handle?

Lauper.

Alright. I follow her as well, everyone else should too. Thanks so much for having us, and, hope you're all enjoying the meeting.

Hello. I'm Jonathan Kay reporting from the first day of ACR Convergence twenty twenty four in Washington DC. Today at abstract four sixty four poster, there was a presentation about paraoxonase one as a predictive biomarker for progression from anti CCP positive patients at risk for developing rheumatoid arthritis to developing inflammatory arthritis. Paroxonase one is an HDL associated enzyme which is involved in metabolizing oxidized lipids, and elevated levels of paroxonase one are associated with a reduced risk of cardiovascular events. In this study, the investigators looked at the sera cohort of anti CCP positive patients at risk for developing rheumatoid arthritis collected at University of Colorado by Kevin Dean and colleagues, and looked at paraoxonase one levels and found that paraoxonase one, when elevated, actually predicted a decreased risk of progression to inflammatory arthritis.

So this is very interesting. This is an enzyme on HDL cholesterol, which metabolizes oxidized lipids and seems to both decrease the risk of developing cardiovascular disease as well as decrease the risk of progression to rheumatoid arthritis. Future studies should be directed at looking at the genes and coding for this protein and look for associations between genetic polymorphisms and progression to inflammatory arthritis. This will be a very interesting area to study because there are large cohorts of patients with rheumatoid arthritis who've had increased risk of cardiovascular events. For example, those in the oral surveillance study treated with tofacitinib, and to see what the correlation might be between paroxinase one and cardiovascular events on a JAK inhibitor.

Very interesting topic, much to come in the future. I'm Jonathan Kaye from ACR Convergence twenty twenty four in Washington. For more on this and other abstracts, please go to roomnow.com.

Hi. This is Arti Kavanagh coming to you from ACR Convergence twenty twenty four, and here we are in DC. Very pleased to be here. The meeting is just getting started. A lot of abstract to be presented.

The posters are out today. Lot of things in psoriatic arthritis about which I'm very interested. This morning though, there was a session which I think is really relevant to psoriatic arthritis and to other rheumatic diseases, and that was about weight loss and specifically the weight loss drugs. They reviewed particularly the SGL-two and GLP-one related mechanisms. A lot of exciting data on there.

Weight loss, improvement in disease outcomes, and we've seen that published now. This is critically important in psoriatic arthritis, where we know the negative impacts of comorbidity, including the metabolic syndrome. In the session, they also went over the cardio renal axis, which is part of the new consideration for the metabolic syndrome and how these medications particularly can improve that. A little bit of a downside that was shown was that when the patients stop these medications, they really lose a lot of benefit that they had had. So it may be that you need to persist on these medicines, although it was raised that maybe you could potentially taper the medicines.

If it's every week, cut that to every ten days or so to still hopefully maintain some of the benefit. The treatments may also, in addition to helping weight loss, which is very important, may have an anti inflammatory property. So this was kind of an intro. We don't have a ton of posters that are addressing this, but they're coming. There's a lot of interesting studies, and the one thing that I found amazing was that it's projected that there'll be more than a dozen of these medications available in So the coming this is Arti Kavanaugh for RheumNow and coming to you from ACR Convergence.

Exciting meeting, lot of data still to come. Tune into RheumNow to hear about it.

Hi. I'm doctor Sheila Reyes from The Philippines reporting live here in Washington DC for the ACR Convergence twenty twenty four. I'd like to talk about abstract zero five seven one. It's an interesting abstract because it talks about the gender specific differences among the disease activity measures in ACPA and how these disease activity measures would affect gender. This study was from the group by Doctor.

Sabrina Hamroun. The objective was to evaluate the influence of gender on disease activity assessment tools and the ability of these disease activity tools to discriminate the PAS or the patient acceptable symptom state based on gender. So what are the findings? They showed that in the overall population of the axSpA patients, VASDDI, ASDAS CRP, and the patient global assessment performed well in discriminating paths, meaning that they were able to get clinically significant or relevant results from the trial. More importantly, VASDI scores were seen to have better discriminating performance in women, whereas ASDAS CRP did not really or it was homogenous among the genders.

Okay. So what did this translate for us? Well, I think it makes sense because we know that there are gender differences in AXPA and that women present more with fatigue, with peripheral arthritis, with extra intestinal manifestations, or I mean, extra articular manifestations rather. And so we should also use disease activity measures that would really define or measure those domains. And probably in future clinical trials then, and especially if women are involved, then the, VASD die can be used as a disease activity measure.

Follow me on Twitter at RheumMarampa and tune in to RheumNow for more coverage of the ACR twenty twenty four.

Hi, everyone. I'm Mike Putman. I'm at ACR twenty twenty four in Washington DC. And today, I wanna tell you about abstract seven seventy, is one of the plenary sessions on the first Saturday of the morning. Now, this was a long awaited study and, full disclosure, one that I participated in but did not manage to enroll any patients.

It investigated the Janus kinase inhibitor upadacitinib against placebo among patients with relapsing and new onset giant cell arteritis. Most of the patients in the study were actually new onset, about seventy percent, and all of them were randomized to either fifteen mg padacitinib, seven point five milligrams of padacitinib or placebo. Now, this is a really important question. We have currently one approved medication for giant cell arteritis and I think we all have been awaiting some of these trials coming down the pipeline to tell us about new mechanisms. So the interesting thing about this study is the people in the placebo group got a fifty two week steroid taper, quite a lot of steroids, similar to the prior GIACTIV study.

The people who got upadacitinib all received a twenty six week steroid taper. So for me, even if they had held serve, that probably would have been considered a success. What did they find? Even better than that actually. So at week 52, the rates of sustained remission were forty six percent in the upadacitinib fifteen milligram group versus twenty nine percent in the placebo group.

So we gave less steroid and we had a substantially, significantly higher rate of sustained remission at week fifty two. Those results held across many, many other things that they evaluated: facet fatigue scores, patient reported outcome measures, various other ways to assess remission and response in giant cell arteritis. I would say kind of across the board it was a successful study and one that I would expect to go on to get approval. A couple other things to note. The first is obviously the concern about safety for Janus kinase inhibitors.

We have not necessarily seen that with upadacitinib, but we have also not run a study comparable to the oral surveillance study where we saw that risk with tofacitinib. So something that's sort of out there in the that makes it a little more challenging. I will tell you when I have approached patients regarding this medication and said, I think this might work, but there is this potential risk of cardiovascular events and the malignancy, folks who are by definition over the age of 50 are all quite worried about those things and it has been a tougher sell than I think you would expect. And then the other problem, and this is a problem that's sort of endemic to the way that we run trials, is that we compared upadacitinib to placebo, which is reasonable. The clinical question here was, does this work at all?

The question that I also would like to know as a practicing clinician is, is this better than the alternatives, namely tocilizumab, perhaps some other conventional synthetic DMARDs? And at this point, we don't really know that. I could see a creative network meta analysis ferreting that out, but I think in the interim it'll probably be up to clinician judgment and the particular mix of your patient's comorbidities and preferences. So this is me, Mike Putman reporting, from ACR twenty twenty four. Be sure to follow along with all of RheumNow's coverage and thanks so much for having me.

Hi, I'm Doctor. Janet Pope at Janet Bourdeaux. I'm here at RheumNow at the ACR twenty twenty four. I wanted to talk about CAR T therapy, and I'm kind of thinking about are there too many carts or CAR Ts for the horses we have? What do I mean by that?

At this meeting alone, there are eight CAR T abstracts. One of them is, abstract four. And these are exciting, but here's the problem. They're uncontrolled. They might be transformative, but we don't know what patients to choose.

And right now with 40 companies or more and counting that are doing CAR T therapy in the autoimmune space, including lupus, we really have to have some decisions. Do we have to have a control group? What does that control group look like? Do we need to precondition? Do we need to stop their meds?

Is the safety outweighing, and benefit outweighing each other or not? So the bottom line here is I'm excited about this therapy, but a bunch of one offs or three off patients are not gonna be transformative for my patients. The cost has to go down, and we really have to know who should get which CAR T and then how long does it last. So please follow us at RheumNow and enjoy the meeting. Thank you.

Hey. Good morning, everyone. I'm Gabriela Sanchez, and I'm currently at ACR in 2024 in Washington, DC. And I wanted to talk to you about a very interesting abstract that I read about today, and it's a very easy abstract to remember. It's number three three three.

So this is a brief summary that I'll be talking about. So this abstract talks about the prediction of transplant free survival in patients who have idiopathic inflammatory myopathy associated interstitial lung disease. In this very interesting study, they had a cohort that was of one hundred and three patients, so good end size. And they did a univariate analysis to assess which variables would be associated with worse outcomes and which variables would be associated with better outcomes. And they found that in patients with idiopathic inflammatory myopathy, associated ILD, we'll call it IIM ILD for now, increased age, pulmonary hypertension, a relative decline in for one year, and worsening shortness of breath for two years was associated with significant predictors of mortality at five years.

Conversely, some variables were associated with improved outcomes, which were muscle involvement, higher baseline DLCO, and higher FVC1 at one year. So go check it out, abstract three thirty three.