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Anti-Rheumatic Rx

EULAR 2023 – Day 4 Report

Jun 05, 2023

Day 4 was a half day closeout to the EULAR 2023 Congress. For me the big presentations were the late breaking abstracts, although there were other review and abstract sessions for those remaining.  Many people missed the last day (June 3rd) of the meeting as a pending Milan airport strike on

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Clinically suspect arthralgias: justified or artefact?

Jun 05, 2023

Some subjects in rheumatology seem to create contention the more they get explored, and one of those areas is a traditional crowd favourite for discussion at EULAR - clinically suspect arthralgias. At EULAR 2023 in Milan, the perfect platform was provided for an airing of grievances, in a

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Important from @cappelliMD @jhrheumatology irAE cohort on predictors of DMARD requirement in ICI-inflammatory arthritis, and persistent ICI-IA post-ICI cessation. The better we can predict these patients, the more we can get the right therapy early POS0951 #EULAR2023 @RheumNow
The incidence of MACEs at 8 years is low in AS patients treated with NSAIDs. Study of 22929 patients, NSAIDs (SHR: 0.40 [0.32-0.49], p<0.001) and anti-TNFs (SHR: 0.61 [0.47-0.81], p<0.001) associated with a lower risk of MACE, Fakih O, Abst#POS0301, #EULAR2023 @RheumNow
meds for PsA at #EULAR2023 recommendations bDMARD after csDMARD (no order proposed) @RheumNow
How do we improve MTX adherence? Biochemical measure of MTX adherence 37% of patients starting a biologic do not take their MTX (!) Those who do respond better to first Biologic at 6 Mo than those who don’t 37% biologic responders = non adherent POS0313 #EULAR23 @Rheumnow

EULAR 2023 – Day 3 Report

Jun 02, 2023

Day 3 was a sunny warm day in Milan at the 2023 EULAR Congress meeting. Here are a few of my favorite abstracts from today.

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The key data for treating clinically suspect arthralgias (CSA): TREAT-EARLIER (MTX) ARIAA, APIPPRA (abatacept) but what we need to do going forward: stratify pts better for studies predict individual risk better, to weight up risk-benefit of intervention #EULAR2023 @RheumNow
Tune it at 1pm EST for RheumNow's daily #EULAR23 recaps. You can find us live on Twitter, YouTube and LinkedIn.
Study on folylPG synthétase (FPGS) activity and MTX-PG measured in sperm showed low bio active form of MTX-PG, low FPGS activity resulting in lower capacity to form MTX-PG, Perez-Garcia LF, Abst#OP0224 #EULAR2023 @RheumNow
Herpes Zoster vaccination in RA patients treated with Upadacitinib and MTX showed a satisfactory response, slight reduction in response compared to general population in both antibody and cell mediated responses Winthrop K, Abst#OP0225 #EULAR2023 @RheumNow
To treat or not? Clinically suspect arthralgia does affect QoL including function. Both premises of treating with a DMARD are valid. OverRx v missing the very early window of opportunity @RheumNow #EULAR2023 @eular_org
For our rheum patients who have had cancer previously - the default can’t be to not have DMARDs. @eular_org points to consider SLR: no clear risk, across b/tsDMARDs For too long these patients were unnecessarily asked to ride it out. No more please POS1069 #EULAR2023 @RheumNow
Should immunosuppression be used to improve #PAH in #SSc added to PAH Rx (85%) Morbidity or mortality outcomes >700 pts - half had a DMARD after dx RheumNow #EULAR2023 OP0238 Targeted Rx improved esp RTX\TCZ findings V interesting results #GameChanger May change my Rx practice!
Retro French database study shows reassuring data. Overall mortality after IRAEs =similar between pts receiving b/tsDMARDs vs. those who don't 70000+ pts treated w/ ICI, 7800+ IRAEs (most frequent colitis) & 330 treated w/ b/tsDMARDs, 10% Rheum IRAE OP0270 @RheumNow #EULAR23
Malignancy in real world datasets: do we see differences between DMARDs - particularly JAKi, with ORAL Surveillance in mind? RABBIT German data (limited risk window): Point estimates slightly up vs TNFi, esp in high CV risk pts but magnitude not big OP0218 #EULAR2023 @RheumNow
Men trying to conceive were prev told to avoid MTX. Another myth busted Why? Spermatozoa lack the FPGS enzyme responsible for MTX-PG metabolism, the tiny amount of MTX-PG in sperm isn’t active. No quality issues! OP0224 #EULAR2023 @RheumNow (& @ARD_BMJ

EULAR 2023 – Day 2 Report

Jun 01, 2023

Day 2 at the international EULAR Congress meeting is always bigger and busier. There were sessions on JIA therapies, crystal arthritis, novel drugs for SLE and Sjogren's, early RA and preclinical RA interventions, IgG4 disease, osteoporosis and the growth and application of artificial

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Obesity in #AOSD – predicted the development of a chronic disease course and biologic DMARD failure, 139 pts with AOSD- 19% Obese (BMI>30) observational study. abst#AB1503 #EULAR2023 @rheumnow
ANSWER cohort Retrospective study 6600+ bio/tsDMARDs ttmt courses, 20 yrs ✔️IL-6Ri is the lowest discontinued for lack of efficacy ✔️CTLA4-Ig is the lowest discontinued due to AEs ✔️Concomitant GC ⬆️30% drug discontinuation due to AEs @Rheumnow #EULAR23 POS0051
Treatment of IIM, MTX or AZA or IVIG are 1st line (with steroids). #EULAR2023
CareRA trial: 3 months addition of LEF vs. ETA in pts resistant to COBRA-Slim regimen (MTX 15 mg/w + step-down prednisone): After 2 years, no difference in dis control but those who received ETA early were treated more frequently w/ csDMARD monotherapy #EULAR23 @RheumNow OP0129
“You don’t need MTX with TCZ for RA” Err, well: - just like TNFi, you def can get ADAb to TCZ - they definitely lead to lower response rates - MTX co-admin reduces ADAb Seems like a good idea to me, but your call 🤷‍♂️ Bitoun, Mariette et al POS0630 #EULAR2023 @RheumNow
No relationship between MTX-PG levels in terms of efficacy by SDAI remission but higher MTX-PG levels related to adverse events by Tamai H, Abstr #OP0128 #EULAR2023 @RheumNow
How much MTX do we need with adalimumab in RA? Can blood concentrations help? MTX RBC polygluts: - don’t seem to match to efficacy - do seem match to safety, a bit (no ADAb data here) *One day* we’ll get better at what MTX dose is needed with TNFi #EULAR2023 OP0128 @RheumNow