Vitamin D and Lupus Outcomes (11.21.2025)
Dr. Jack Cush reviews the news and journal reports from this past week on RheumNow.com.
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Upadacitinib: revisiting safety data in RA and GCA
For the last several years, conversations about JAK inhibitors have often started and ended with safety. The shadow cast by ORAL Surveillance has made clinicians more cautious and regulators more restrictive. Yet in practice, https://t.co/6Wes2npkFd
Dr. John Cush @RheumNow( View Tweet )
Deucravacitinib and Renal Function: Insights from the PAISLEY Trial
In the phase 2 PAISLEY trial, deucravacitinib met its primary and secondary endpoints, demonstrating efficacy across multiple clinical and patient-reported outcomes. However, the impact on renal function has remained unclear. An abstract presented at ACR provides new insights.
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Should we be using JAKi more in female SpA patients?
In recent years, data has emerged suggesting that female patients with spondyloarthritis, both psoriatic arthritis and axial spondyloarthritis, may have worse outcomes than male patients. A number of post-hoc analyses of https://t.co/smLao0q2hv
Dr. John Cush @RheumNow( View Tweet )
Tofacitinib in AxSpA in Developing Countries
Dr. Antoni Chan reports on abstracts 0582 and abstract 0554 presented at #ACR25
https://t.co/4kTv90PhIC https://t.co/WRUBP0O21b
Links:
Dr. John Cush @RheumNow( View Tweet )
ACR25 Best Abstracts - Day 4
Here's the last installment of our "ACR Best" abstracts as chosen by the RheumNow faculty. Most of these were from the final, day 4, but a few were noteworthy holdovers from day 3. Enjoy!
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Excited about this target trial emulation in RA-ILD
Compared to RTX, NO significant difference in hospitalization/transplant/death for JAK, ABA, IL6 or TNF
Trends toward ABA and JAK looking better than RTX
Need trials for sure, but I like this project a lot
@RheumNow #ACR25 https://t.co/FQcphRvyHK
Links:
Mike Putman @EBRheum( View Tweet )
#Deucravacitinib #Tyk2i in active #PsA to 52weeks
#PBO was crossed over at 16weeks
Ongoing improvement for high bar outcomes ex % in #minimal #disease #activity #MDA
#Xray #progression was reduced with real data (not imputed)
#ACR2025 @RheumNow @ACRheum https://t.co/kAMym2x8HQ
Links:
Janet Pope @Janetbirdope( View Tweet )
Stopping therapy in GCA
They say the easiest bit about GCA, like PMR, is the first week after you start steroids. Those fond memories belie the challenge of ongoing treatment in GCA. In a steroid-only world, there is only misery. Steroid-sparing therapies have changed this completely.
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Deucravacitinib (TYK2) in PsA from POETYK trials
Improved ACR20 at wk16 (NNT ~5), less benefit for ACR70 (NNT ~20)
Steady improvements during open label extension (all pts received drug)
Would expect approval for PsA soon... where will this fit in your approach?
@RheumNow https://t.co/325h2hf0AE
Links:
Mike Putman @EBRheum( View Tweet )
Year in Preview
GCA: GC over-prescribed, bDMARDs more effective than MTX, and more options available (TOC, JAKi)
@RheumNow #ACR25 https://t.co/L9fx1LCCnw
Links:
Jiha Lee @JihaRheum( View Tweet )
#ACR25 Abstr#LB20 At EULAR, data for Phase 3 RCT of Deucravacitinib, Tyk2-i in active #PsA showed ACR20 was met at WK16. Here, data showed sustained response through WK 52 across core domains inc. those who switched PBO->DEU. No major safety assoc. with JAK-i.A few acne @RheumNow https://t.co/tmzQMOtjev
Links:
Md Yuzaiful Md Yusof @Yuz6Yusof( View Tweet )
POETYK PsA 1 and 2 Deucravacitinib TYK2 inhibitor Ph3 RCT
52 wks data
Deucra 336pts PBO 334pts then crossover wk 16 to 52
Pooled analysis wk 16
ACR 20 54% vs. 31%
Enthesitis reduction LEI 52% vs. 45%
Dactylics resolution 58% vs. 44%
POETYK-PsA 1 Wk 52
ACR 20 63%
ACR50 44%
PASI https://t.co/LYJbU8fYwI
Links:
Aurelie Najm @AurelieRheumo( View Tweet )
Upadacitinib: revisiting safety data in RA and GCA
For the last several years, conversations about JAK inhibitors have often started and ended with safety. The shadow cast by ORAL Surveillance has made clinicians more cautious and regulators more restrictive. Yet in practice, many of us continue to reach for upadacitinib when we
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Cohort study comparing 3yr safety outcomes of JAKi vs. TNFi in AS pts
JAKi use: ⬆️incidence of HZ infxn but not significant; ⬆️all-cause mortality (HR 4.94) and GI bleed (p=0.04)
Individualize tx. consider potential complications
#ACR25 @RheumNow Abs2633 https://t.co/pjKAazQFwW
Links:
sheila @RHEUMarampa( View Tweet )
In a retrospective TrinetX analysis of 3 year safety outcome in AS, JAKi use was linked to higher mortality and GI bleeding vs TNFi, but lower malignancy risk. Infection rates were similar, with a trend toward more herpes zoster in JAKi users. Abstract#2633 @RheumNow #ACR25 https://t.co/pPY0wpAKA3
Antoni Chan MD (Prof) @synovialjoints( View Tweet )
Agrawal et al. Case study of tofacitinib + bDMARDs in refractory IA. 7 SpA, 2 RA, 1 JIA. Effective and safe. @RheumNow #ACR25 Abstr#2338 https://t.co/Y0B3W4csJX
Richard Conway @RichardPAConway( View Tweet )
#ACR25 Abstr#LB02 Is there a role for JAK-i for the treatment of IgG4-RD? Opel label RCT in China (N=58) showed NO relapse in Tofacitinib + GC taper vs GC Taper alone (54%). No serious infection. Interesting and a PBO-controlled is warranted @RheumNow https://t.co/dFvAmcGfCT
Md Yuzaiful Md Yusof @Yuz6Yusof( View Tweet )
When every option fails, bold moves remain.
In 5 multi-resistant RA pts, TNFi + JAKi combo brought remission in most without major AEs.
Not standard, not risk-free, but in young, low-infection-risk pts, it may offer a path forward.
@RheumNow #ACR25 Abstract#2272
Jiha Lee @JihaRheum( View Tweet )
To be continued (or discontinued?): Abstract 2360: Compared to TNFi, IL-17i & JAKi users had 🔹 Higher odds of med switching <180 days 🔹 Shorter time to discontinuation @RheumNow #ACR25 #axSpA https://t.co/IOHaFSJqHn
Akhil Sood MD, MS @AkhilSoodMD( View Tweet )
SELECT-COMPARE RA UPA vs. ADA
What do we learn from 7 years data? Not much
Patients who did well on the first drug, keep doing well
Patients who required switching for primary failure don't do as well, w/ 26% pts reaching DAS remission in UPA + MTX vs. 16% in ADA + MTX gp
No https://t.co/JLUTRZuZOm
Links:
Aurelie Najm @AurelieRheumo( View Tweet )
~1 in 6 pts with #sarcoidosis May have #cardiac involvemt
1/3 respond to #MTX + #steroids
Followed by repeat #PET
Failures get
👇
#infliximab >#adalimumab
👇
#JAKi
Better survival >yrs ago
R heart involved ⬆️risk of MTX nonresponse
#ACR25 @RheumNow @ACRheum abst#1664 #ACRbest https://t.co/kYt9JRNSVH
Links:
Janet Pope @Janetbirdope( View Tweet )
SELECT-COMPARE (upadacitinib vs adallimumab in mod-severe RA, no CV enrichment) 7y data:
safety profiles very similar, except for:
- zoster
- CK rise
- lymphopenia
- hepatic disorder
In the general RA population, no new JAKi safety signals
#ACR25 ABST1676 @RheumNow https://t.co/BA2JxONGfa
David Liew @drdavidliew( View Tweet )
Infection data from SELECT-GCA:
Glucocorticoids seem to drive overall infectious risk
UPA use associated with higher zoster - vaccinate!!
@RheumNow #ACR25 Abst# 0895 https://t.co/ueVbFPxG0Q
Brian Jaros, MD @Dr_Brian_MD( View Tweet )
Avouac et al. Lipid changes after JAKi initiation. 85 patients. Increases at 6 months. Largely appeared driven by HDL increase, and correlated CRP decrease. Appeared transient with return to baseline with time. @RheumNow #ACR25 Abstr#1333 https://t.co/CQ6u3ck1Ch
Richard Conway @RichardPAConway( View Tweet )
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