Lupus Nephritis
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Dr. John Cush
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Dr. John Cush
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EGPA Treatment: A new Era with the E-MERGE trial?
EGPA is the rarest of the ANCA-associated vasculitides. Compared with GPA and MPA, EGPA has a mechanistically distinct pathophysiology involving eosinophil-mediated inflammation. This distinct mechanism has driven the https://t.co/gP5y6rCUJH
Licia Mota
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Could environmental exposure trigger RÃ?
#ACR26: In ACPA-positive individuals, PFAS exposure in drinking water and serum was associated with increased risk of progression to RA.
A provocative finding linking environmental pollutants to RA development.
@RheumNow #ACR26 https://t.co/GWlRKGh8HB
Licia Mota
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Can AI help discover the next generation of oral immunomodulators?
#ACR26 Abst 066: AI-guided discovery identified 66882BD, a small-molecule TL1A antagonist with confirmed target binding and functional activity.
A promising step toward oral TL1A-targeted therapies
@RheumNow https://t.co/iGFlVmxOtt
Janet Pope
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#GCA #Flares in year 2
Of #upadacitinib in remission
at end of yr 1
Randomized to
UPA-UPA
Vs
UPA-PBO
No surprise, on Yr2 PBO
⬆️flares
⬆️pred
⬆️CRP & ESR if flare but higher in no Rx group
Take home Rx likely needed for 2 yrs in #GCA
#ACR26 @RheumNow @ACRheum
#abst1892
sheila
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In this real-world cohort study using TriNetX data by Dr Singh et al, SGLT2i use in non-DM LN showed lower 3yr cumulative event rates for ESRD/dialysis, heart failure, AKI & high gr proteinuria
Promising data for SGLT2i in non-DM LN. More studies needed.
@RheumNow #ACR26 Abs1867 https://t.co/FPe5ZmAxYN
Dr. John Cush
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The Weight of Evidence
Every rheumatologist knows this patient. Her ASDAS is 3.4. Her CRP is normal, her MRI is quiet, and she is on her third biologic. The reflex is to reach for a fourth. Abstracts from #ACR26 make a quietly radical case against this reflex. https://t.co/skjZIJuq1u
Richard Conway
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Samson et al. RCT (open-label however) Ustekinumab in GCA. 38 patients. Primary endpoint week 52 (alive+sustained remission+<10% deviation from steroid protocol) 45% vs 12% (p=0.028) Relapse rate week 52 50% vs 88% (p=0.013) @RheumNow #ACR26 Abstr#1896 https://t.co/P51ZLklEMA
Brian Jaros, MD
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To pulse or not to pulse
Emulated target trial using retrospective AAV data tx for severe flare
Many baseline differences between pulse vs. no pulse so propensity matching used
NO difference in composite of death, ESRD, remission, relapse
@RheumNow #ACR26 #Abst1154 https://t.co/cu5N5rMnj1
Richard Conway
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Dua et al. Sarilumab vs MTX in PMR. Retrospective claims based study. Outcome = median days to glucocorticoid discontinuation, Sarilumab superior to MTX. @RheumNow #ACR26 Abstr#1895 https://t.co/868B6vuYk4
Brian Jaros, MD
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Who stays on PsA Therapy?
British prospective PsA registry: 815 pt on b/tDMARD
Factors affecting drug d/c:
- PDE-4 use
- higher BMI
- enthesitis
- lower physician global assessment
- polysymptomatic stress
Protective:
- concomittent csDMARD use
#Abst1324 @RheumNow #ACR26
Mike Putman
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High rate of PMR relapses post treatment withdrawal
REPLENISH (RCT of SEC vs PLBO in PMR) post hoc study followed pts AFTER 52 week period ended (ie both arms off therapy)
Relapse occurred in 43% in SEC vs 62% in PLBO; relapse free survival longer with SEC, even w/all pts OFF https://t.co/DfQWj6mMKB
Eric Dein
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Fiber prebiotic for RA?
#ACR26 @RheumNow
1 month high fiber intervention reduces pro-inflammatory cytokines
54 pts active RA given fiber supplement. Decrease DAS28 4->3.1, p=0.04
RCT of inulin - impr DAS28 (p=.02), TJC, SJC, CRP. Not in VAS pain/ESR https://t.co/rWvVdGy0EP
Daric Mueller, PA-C
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DM-ILD pts enrolled in Ph3 brepocitinib (VALOR) trial encompassed 20% of study population. Subgroup analysis sees improvements in TIS and steroid sparing effect regardless of ILD status. Abstract 1586, #ACR26 @RheumNow https://t.co/oKebDrAE9E
Richard Conway
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SCOOT study. S/C MTX better than split dose oral. 252 patients. Odds of EULAR mod/good response at 16 weeks significantly lower with oral split-dose (adjusted OR 0.55, p=0.049). EULAR good response (OR 0.53, p=0.032), ACR50 (OR 0.51, p=0.011) @RheumNow #ACR26 Abstr#1416 https://t.co/1w4VU1qn0p
Adela Castro
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Prevalence of SpA features in IBD:
-Meta-analysis of 81 studies (>110,000 IBD patients, 23 countries): pooled prevalence of SpA features in IBD was 13.4% for peripheral arthritis, 8.9% for sacroiliitis and 3.5% for AS.
-Twelve studies contributed incidence data: the largest https://t.co/77hqhWaPi9
Mike Putman
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Nice study using RISE registry; avacopan hepatotoxicity is rare but real
Out of 238 users in RISE, two suspected DILI cases (0.8%) occured w/in 3 months of initiation (highly probable assessed causality). No VBDS and both recovered
Supports close monitoring & informed consent https://t.co/WYwE9Va0Zy
Mike Putman
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RWE multicenter cohort: avacopan benefit largely concordant with ADVOCATE study
64 pts w/severe GPA/MPA who received avacopan compared to historical conrols
No difference in time to remission (adjusted HR 0.80, 95% CI 0.56-1.15) & no change in renal trajectory, but improved https://t.co/9mzrcCnEET
David Liew
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How well do we do glucocorticoid-induced osteoporosis in RA?
@earlyarthritis cohort of RA in >50yo, PNL ≤7.5 for >3mo
guidance suggested 1. Ca supp 2. vit D supp 3. BMD or OP Rx
Performance not great but I'm sure I've done no better
Needs work!
ABST1783 #ACR26 @RheumNow https://t.co/8L2CnOoCXQ
Richard Conway
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Singh et al. VA study. 81505 patients. HCQ associated reduced mortality in SLE and RA (but not OA). @RheumNow #ACR26 Abstr#1415 https://t.co/c0epUWxjoj
Mrinalini Dey
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Why do MTX metabolite profiles vary? PROMOTE/JIA linked FPGS variants to lower long-chain:short-chain MTX-polyglutamate ratios in a genetic analysis of 140 children. Supports precision medicine strategies aimed at identifying non-responders early in JIA #1824 #ACR26 @Rheumnow
David Liew
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Mass adalimumab biosimilar switch at the VA
only 1.3% switched back
$132m saved
those debates we used to have about biosimilar switching seem like a different era
ABST1418 #ACR26 @RheumNow https://t.co/ayrmtr4H5A
Richard Conway
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Richez et al. RCT MTX+Metformin vs MTX in RA. No benefit seen @RheumNow #ACR26 Abstr#1398 https://t.co/JyGqbkaKxq
Jiha Lee
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Obese patients clear biologics faster: matching a 70 kg exposure takes about 40% more adalimumab at 107 kg.
Options: more frequent dosing, weight-based drugs (IV), drug levels.
No dose-escalation trials in obesity yet.
Session: Size Matters @RheumNow #ACR26 https://t.co/99jw3Vz5l6
Mike Putman
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Strong data re:skin outcomes from VALOR, RCT of brep in dermatomyositis
NNT for skin remission ~4 (CDASI-A >14: 43.5% vs 20.8%), itch remission ~5 (itch remission <=1: 43.2% vs 24.1%), & itch improvement ~ 2 (74.0% vs 33.3%)
Itch is underappreciated & frustrating; nice data for https://t.co/tJus4RXwod
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