Anti-Rheumatic Rx

Why Did the Last Drug Fail? When a patient fails a drug, we tend to consider what will be the next drug. Most of our clinics have patients on their second or third advanced therapy. Drug failure has become more common, not less. A question that we too rarely write in the notes https://t.co/r5mQjI79iQ

Making the Case for Early Biologics in Lupus A new diagnosis of SLE can be overwhelming for patients. The decision to initiate biologic versus non-biologic therapy early in the disease course may have far-reaching implications for disease control, glucocorticoid exposure, and https://t.co/CmTeHTwzZw

PMR: Spare The Steroids Please Steroids remain both the cornerstone and the Achilles' heel of PMR management. We have aspirations of briskly tapering our patients once they have had their honeymoon phase with prednisone. But when Ms. Jones calls you with a reported second PMR https://t.co/dbrdVZRuoN

All RA-ILD deserves a trial of immunomodulation The optimum treatment approach in RA-ILD remains an area mired in controversy. This is evident from the contrasting views taken by the 2 recent expert guidelines from ACR and EULAR, which advocate for very different treatment https://t.co/vxr8NDruGI

New Treatment for Fibromyalgia? Will It Help or Harm? For years, the pharmacologic treatment landscape for fibromyalgia has remained relatively unchanged, with limited therapeutic options despite a substantial disease burden. This condition is characterized by chronic https://t.co/nn9wu7xibY

Biologic Dosing and Obesity A 46-year-old with pSa and a BMI of 38 still has active disease on adalimumab (Humira) 40 mg every other week. What do you do? Stephen Balevic, MD, PhD, discusses this question in "Prescribing the Right Dose: How Obesity Alters Drug https://t.co/0SGQGs32U2

It's like HCQ on steroids (metaphorical not literal, & anabolic not glucocorticoid) TLR7/8 targeting in SLE (IFN-I, GC resistance, organ damage) ph2: massive signal in primary, secondaries all hit, IFN-I down from w2, safety good what a time for lupus ABSTLB23 #ACR26 @RheumNow https://t.co/mhntxC4aT4

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Is it the treatment or the disease? -Multiple meds can cause SCLE: more widespread, EM,Bullous features. -Dupilumab can cause enthesitis: if severe needs dc of medication -Anti-CD 20 may cause IBD (Crohn’s-Like) Great lecture from @md_chawla on Drug induced syndromes #ACR26 https://t.co/EEQL7QNtWC

Single ctr retros study Inadeq response (IR) to DEN 37 pts had IR In IR who developed fractures, incr prev of prior vertebral fractures, older age, low fem BMD, incr GIOP In all IR pts, incr CTx values during DEN tx lack of specific criteria for DEN-IR @RheumNow #ACR26 Abs2957 https://t.co/Oxg2k4OSdT

Spanish retrospective study by Funcia et al on DEN discontinuation & fracture incidence 7% developed fractures after DEN dc Incr fall risk was the only significant factor identified Causes of discontinuation: Poor adherence, other causes & AEs @RheumNow #ACR26 Abs2956 https://t.co/lSSJMrxVuk

Prospective cohort study of DEN for OP in RMDs: Sustained incr in BMD of the lumbar spine Sustained significant reduxn of bone turnover markers Pts on GC, DEN significantly incr BMD of the lumbar spine @RheumNow #ACR26 Abs2954 https://t.co/qoOCXKZ7DX

In this cohort study on tx persistence by Dr Sari et al, patients w/biologic naive axSpA who started their 1st biologics show that pts who started w/n 5 yrs had 30% lower risk of stopping their 1st biologic (maj. of pts received TNFis) @RheumNow #ACR26 Abs2945 https://t.co/OzQTrmZ9Yt

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Rituximab in RA: low IgG was associated with serious infection (HR 6.25 after baseline-IgG adjustment; 95% CI 2.54-15.39). Longitudinal IgG monitoring before each RTX cycle is suggested based on these data. @Rheumnow #2931 #ACR26

52 wk data of TOGETHER-PsA: Ixe + Tzp for PsA Ixe+Tzp achieved ACR50 resp & change in body wt thru 52wks; noted superiority by 36wks vs Ixe alone; greater dse control, wt, & metabolic control AEs comparable w/ wk 36 results. Low GI d/c rates @RheumNow #ACR26 Abs2942 https://t.co/MorFe1A4OZ

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Dazodalibep (CD40/CD40L inhibitor) for Sjogren's Improved ESSDAI at both doses compared to PBO Q4 week dosing w/ improvements in dryness Sig. improvement but PBO also did fairly well... how much is an ESSDAI delta of -1.4 to -1.8 clinically meaningful... @RheumNow #ACR26 LB22 https://t.co/AEBtjpJq1F

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Just as tofacitinib goes generic, have we found a better option? TARA = giroctinib (JAK1/TYK2) vs. tofa in severe/refractory RA 39% with prior JAK exposure Week 4: ACR50 ~15% vs. 6% Week 24: ACR50 73% vs. ~50% Similar infx risk esp zoster, no MACE @RheumNow #ACR26 LB21 https://t.co/ZthsWSoedR

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New drug coming to myositis w/data in immune-mediated necrotizing phenotypes (IMNM) ALKIVIA phase 3 RCT randomized 175 pts to FcRn blocker efgartigimod or PLBO Improved total improvement score (TIS) at wk52 & TIS >=40; also increased serious AEs (21% vs 14% PLBO) Interesting https://t.co/Dqh8Sh9mew

Aggarwal et al. Efgartigimod in myositis, phase 3 ALKIVIA RCT. Effective IMNM and DM in both Total Improvement Score and secondary outcomes. No new safety signals. @RheumNow #ACR26 Abstr#LB24 https://t.co/HCFa26qCMX

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NEW #MOA in #SLE TLR7/8 #Afimetoran Drives Interferon T1 TLR7 Changes organ damage TLR8 1 or more background #lupus #Rx mandated #prednisone taper Aim <7.5mg/d #GCs Mean #SLEDAI 8, CLASI 7-8 Mean pred 9.5-10.5 85%HCQ #ACR26 @RheumNow @ACRheum #LB24 https://t.co/EXCnYdc7O3

LB23: Ph2 trial Afimetoran (TLR7/8 inhibitor) in pts w active SLE - all 3 doses higher SRI-4 response v PBO: 64.1%-67.8% vs 34.4% - secondary measures c/w with SRI-4 (BICLA, LLDAS, GC sparing, & others) - infection most common reported AE @RheumNow #ACR26 https://t.co/5WGDCHygcP

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OASIZ-301 Trial- Dazodalibep for SjD Both DAZ arms (3000mg & 1500mg) demonstrated sign. improvements in ESSDAI at wk 48 vs PBO DAZ arms also met key sec endpts - including sign. improved ESSPRI/DASPRI dryness domains w/1500mg Both arms safe & welltolerated @RheumNow #ACR26 LB22 https://t.co/GjnDCWkMG7

Kalunian et al. Phase 2 RCT of Afimetoran, oral TLR 7/8i in SLE. 248 patients. Met SRI-4 in all groups. No dose dependent effect. Less serious adverse events with afimetoran vs placebo. @RheumNow #ACR26 Abstr#LB23 https://t.co/jlTO5OeD2N

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In the head to head BE BOLD trial, 553 patients with active PsA received bimekizumab or risankizumab. ACR50 at week 16 was 49.1% against 38.0%, meeting the primary endpoint, and the advantage was sustained to week 24. Minimal disease activity did not separate significantly, so https://t.co/i6rDNgtFiV

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TARA phase 3 (n=459): after bDMARD failure, week-24 ACR50 was 73.0% with girocitinib vs 49.5% with tofacitinib (p<0.0001). Serious infections: 3 vs 4. Findings support girocitinib as a promising treatment option for refractory RA. #LB21 #ACR26 @Rheumnow https://t.co/mjWW8GgRkm

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TARA trial: Ph3 H2H trial of Girocitinib (JAK1/TYK2i) vs Tofa in RA refractory to bDMARDs Giro achieved higher ACR50 response vs Tofa at wk24 (73 vs 49.5%) Also met secondary endpts Safety data: Infections more common. No VT/malignancy/MACE in Giro arm. @RheumNow #ACR26 LB21 https://t.co/HNVt7WdLc6