Lupus

van Schaik et al.SYNBIOSE-2 trial. Rituximab+Belimumab in severe SLE and/or lupus nephritis. HR 0.39 [0.19-0.77], p=0.005 for treatment failure. BUT the SOC comparator in this trial (MMF+pred) is no longer SOC (at least in lupus nephritis) @RheumNow #ACR26 Abstr#LB07 https://t.co/zAHjx7z4W6

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Important post hoc of RITAZAREM study (RTX vs AZA in AAV) Off-maintenance study of pts who completed study; higher relapse free survival in RTX at 6 mos (95% vs 72% AZA, NNT ~5) & 12 mos (82% vs 61%) Detectable antibodies predicted RTX failures (HR 8.2), ANCA positivity in AZA https://t.co/VvUL5Xmccr

Khosroshahi et al. IgG4-RD. In smokers higher Hospitalization (RR 2.08), cardiovascular events and death (RR 1.74). Immunosuppressive escalation more frequent in smokers (RR 1.50) @RheumNow #ACR26 Abstr#2110 https://t.co/nno0scjF09

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Lupus nephritis: prognostic value of biopsy timing & histology Abst 2269: • Biopsy >90d from first LN sign: dec. odds of complete/partial renal response at 1y (aOR 0.30) • Chronicity >3: inc. odds CKD/ESKD/transplant at 1y • Activity >10: inc. odds ESKD #ACR26 @RheumNow https://t.co/20GeZCJWBD

What is the efficacy of enaptoran (TLR7/8 inhibitor) in SLE? Abstract 2202 Phase 2 WILLOW study: enaptoran v placebo - Improved BILAG MSK score - Greater reduction in >50% tender/swollen joint - significant diff in BICLA response in pts w MSK nad skin @RheumNow #ACR26 https://t.co/3Lv2Spga0K

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Interim results of ambitious phase 2 study of iptacopan in AAV Similar BVAS remission at week-24 similar between groups (84.6% vs 83.3%) and preliminary 48 week analysis suggests iptacopan is... similar to RTX for maintenance? Not buying it. Need to see longer f/u (I'd bet https://t.co/gP7PogQetH

Placental lesions assoc w/ adverse preg outcomes (APO) in SLE: 44/57 had APOs (preterm, preec, SGA) Placentas of SLE w/ APOs vs. SLE w/o APO: Higher maternal vasc malperfusion (MVM) [77 vs 31% p0.005)] predominantly the AVM phenotype (64 vs 15% p0.004) @RheumNow #ACR26 Abs2461 https://t.co/HYOdUUztbs

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The Problem of Pain in SLE 372 adults with SLE in FORWARD (National Databank for Rheumatic Diseases) evaluated nociplastic (Type 2: based on PSD scale) vs inflam. (Type 1) disease activity overlap and change over time. -At baseline: 36% Minimal, 21% Type 1, 6% Type 2, 37% Mixed.

Cohort study by Bernatsky et al: SLE pts had incr cancer risk vs gen pop'n (SIR 1.96) esp for hema malignancies. 75 CAs in their cohort (IR 8.1 events/1000PY); top 5 - BRCA 16, NHL 13, lung 8, bladder 6, colorectal 4 Adopt CA screening strat for SLE pts. @RheumNow #ACR26 Abs2234 https://t.co/QeYljBpPZh

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Iptacopan is used in renal (PNH, C3G), an oral complement pathway targeting amplification upstream of avacopan. Similar encapsulated bacteria issue as eculizumab. It could do a job in AAV, albeit modest. Is it wrong to say I miss avacopan already? ph2 ABSTLB16 #ACR26 @RheumNow https://t.co/MYyW3ethQJ

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Beyond CD19: engineered islet-specific Tregs in recent-onset T1D GNTI-122, phase 1, single dose 10^8 cells (n=3), 10^9 (n=3), 10^9 + rapamycin (n=10) DRB1*04:01+ only, 78 wk f/u DRB1*04:01 is the RA shared epitope. RA should be next. Jane Buckner @RheumNow #ACR26 https://t.co/KF7FnnPpnz

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Prevalence of ANCA in SLE & LN: 33% in SLE pts w/ +ANCA and had incr odds of LN, low C3 &/or C4, +anti-Sm 19% in LN pts w/ +ANCA and had incr odds of myositis & photosensitivity; anti-dsDNA & ANA ANCA+ in SLE can help predict symptoms & renal involv’t @RheumNow #ACR26 Abs2236 https://t.co/8YlgYCeMGQ

#ACR26 @RheumNow Ab#2824 FORWARD - type 2 SLE sx (nociplastic, non-inflamm) Scored Inflammatory sx score (SLAQ), Fibromyalgia survey score -59% had high FM score -Opioid use in combined inflamm/FM group -FM scores did not follow inflamm improv 1 in 6 had peristent nociplastic sx https://t.co/lNwhz4uunA

Rapid manufacture zola-cel CAR-T appears to be back on. The SLE patients in the ph1 Breakfree-1 study did just fine for a long time, thank you very much. Conventional CAR-T is not sustainable on the scale we might like, so on with ph2 & watch closely. ABSTLB04 #ACR26 @RheumNow https://t.co/lYWpheX3Cj

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In amongst new meds in Sjogren's, those looking at LEF/HCQ have kept at it. Further French data shows both LEF/HCQ & MMF/HCQ benefit after 24w Rx. While some will definitely need new SjD therapies, some will be just fine on Rx we can get readily now. ABSTLB15 #ACR26 @RheumNow https://t.co/erAgjRPWpL

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Interim analysis from ReBIOLup study by Dr @IoannisParodis show a discordance bet UPCR and activity index on repeat biopsy of LN pts 14.9% w/UPCR <0.5 g/g & NIH AI ≥4 10.6% w/UPCR >1 g/g & NIH AI < 3 Proteinuria not entirely reflective of dse act. @RheumNow #ACR26 Abs1862 https://t.co/SgZmLF6Dz9

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#Damage in #LN>#SLE without LN Despite higher # of IS #immune #suppression as expected N>3700 pts LupusNet Activity higher in LN but reduced over 3yr, Vs flat and lower No LN over Need better Rx to reduce #Nephritis damage #1274 #ACR26 @ACRheum @RheumNow https://t.co/CFa9dVY0R5

#LN cohort Rx w #belimumab DR M Petri observe LN study Showing #preservation of #renal #function w #BEL ☑️partial and complete in 61 pts Renal responses in real world data mirroring the #RCT data #CRR #PRR 87.5 CRR to 94% PRR at 2y #ACR26 #1229 @ACRheum @RheumNow https://t.co/b2XkqawOVl

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NETs: A new biomarker for lupus? Abstract 2840 evaluated utility of composite NET load (formation +degraduation) in lupus nephritis - NETs ↑ during flares and pre-flare - ~ w/ ↑ dsDNA and ↓ complements - Discriminated flares v LLDAS (AUC 0.986) than dsDNA @RheumNow #ACR26 https://t.co/25QwrbIMSa

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#Belimumab in #Real world observational study show ⬆️#survival vs matched controls Safe and MORE effective than SoC DR Michele Petri presented >2000 BEL 947 SoC #ACRBest #1231 #SABLE REGISTRY #ACR26 @RheumNow https://t.co/lPdkwNdBQs

#Obinutuzimab +#RCT in #LN +SoC had subset of renal bx This study looked at uEGF and also renal bx changed #uEGF correlates modestly w #CI #chronicity #index & not #activity Likely improvement is related to ⬇️interstitial fibrosis ☑️in obi>PBO in bx #1232 #ACR26 @RheumNow https://t.co/qPwiP0twV4

@RheumNow abstract #1506 #ACR2026 Exploring interferon signaling and brain health in childhood lupus! Elevated IFN signatures seen in cSLE, but no links to depression or executive function. Intriguingly, higher IFN activity was linked to better cognitive flexibility.

#IgG4 LTE of RCT w #Obexelimab FLare rate ~10% on #Rx OBEx attenuates CD19 signalling via FCYRIlb binding ☑️safety Q still to answer Can we eventually d/c Rx? Which drug to use in IgG4? Long term benefit /risk #LB18 @RheumNow #ACR26 @ACRheum https://t.co/eszycLMo5A

Lupus CVD: Beyond the Lipid Panel At #ACR26, Dr. Mariana Kaplan made a compelling case that cardiovascular risk in SLE cannot be understood through lipids and blood pressure alone. Traditional risk factors matter, but they do not fully explain the burden of premature vascular https://t.co/9yeBTl5xyp

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