Eltrombopag, a Potential New Treatment for ITP
A pilot trial has shown a thrombopoietin receptor agonist, eltrombopag (Promacta), to be effective in connective tissue disease-related (CTD), refractory immune thrombocytopenia (ITP).
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Outcomes Comparison study of late-onset RA (LORA) vs younger-onset RA (YORA) showed similar Dz activity assessments over 5 years but Late onset RA had worse functional outcomes and more adverse events (adj HR 4.7 for death & 2.6 for malignancy). https://t.co/b58zJG1OuA https://t.co/WZa12O06Rf
Dr. John Cush @RheumNow( View Tweet )
Should you worry about giving TNFi to RA pts after a cancer diagnosis?
Medicare data with colorectal, lung, prostate Ca:
TNFi pts survival no worse (numerically better) than csDMARDs
Cancer pts deserve good RA treatment!
#ACR24 ABST0202 Suarez-Almazor @MDAndersonNews @RheumNow… https://t.co/aR75hJQ6YK https://t.co/ptDYCsOpXN
Dr. John Cush @RheumNow( View Tweet )
Best of 2024: Lung Cancer in Rheumatoid Arthritis and Interstitial Lung Disease
https://t.co/Sd3H5Tzhtf https://t.co/guXzL5bc6R
Dr. John Cush @RheumNow( View Tweet )
Best of 2024: Lung Cancer in Rheumatoid Arthritis and Interstitial Lung Disease
A matched cohort study from the Veterans Health Administration shows that rheumatoid arthritis patients have a >50% increased risk of lung cancer, and a 3-fold higher risk of lung cancer in RA-interstitial lung disease (ILD).
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Japanese registry study of CV & CA outcomes in #RA. CV (MACE) events = IR 0.49/100 PY.
Cancer= IR 0.78/100PY. MACE risk factors: Male, age≥65, HTN, Renal or cerebrovascular Dz; CA risk w/ Male, age, NSAID, COPD, SIE, CA Hx. https://t.co/uBFbho25La https://t.co/3ClEwCvdDY
Dr. John Cush @RheumNow( View Tweet )
Summary of JAKi Studies
Dr. Peter Nash, at the 2024 ACR Convergence meeting in Washington, DC, talks about JAKi data presented in: the SELECT-GCA trial and safety signals; ILD; cancer; cycling; RA; uveitis; and new JAKs under study.
https://t.co/ywmtrTi0iF https://t.co/nbFFojL1i4
Dr. John Cush @RheumNow( View Tweet )
Primary Hypophosphatemia (HYPOPH) - Japan study 50,136 adults w/ 424,434 alk phosphatase (ALP) tests. Persistent HYPOPH seen in 0.54% (273) due to cancer(30%), steroids(21%), DMARDs (16%). Unexplained HYPOPH had pain, muscle weakness, fatigue & could have primary HYPOPH… https://t.co/kGPSXSYEZI https://t.co/RtwSRnzeU0
Dr. John Cush @RheumNow( View Tweet )
Primary Hypophosphatemia (HYPOPH) - Japan study 50,136 adults w/ 424,434 alk phosphatase (ALP) tests. Persistent HYPOPH seen in 0.54% (273) due to cancer(30%), steroids(21%), DMARDs (16%). Unexplained HYPOPH had pain, muscle weakness, fatigue & could have primary HYPOPH… https://t.co/8RbSnhS3vl https://t.co/NdRIA4oREr
Dr. John Cush @RheumNow( View Tweet )
Why should rheumatologists care about aging?
The global population is aging and none of our rheumatic diseases are immune to the impact of the complexities and so-called “geriatric syndromes”, including sarcopenia, frailty, falls and cognitive impairment, associated with the aging process. Whilst we are increasingly aware of these
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Playing it Safe with RA? JAK vs. TNF Debate
The ORAL surveillance trial raised safety concerns that the janus kinase inhibitor (JAKi) tofacitinib was associated with an increased incidence of cancer and major adverse cardiovascular events (MACE), compared to tumor necrosis… https://t.co/sUSdRKRxEF https://t.co/XcjOqGlLVX
Dr. John Cush @RheumNow( View Tweet )
Biggest absence award at #ACR24 @ACRheum @RheumNow
🥇
Absence of discussion on
👇
#Oral #Surveillance
Except for maybe
Monitoring for mouth ulcers and cancers
issues are not resolved but we are comfortable with ambiguity!
Janet Pope @Janetbirdope( View Tweet )
Playing it Safe with RA? JAK vs. TNF Debate
Reported safety signals, at odds with the efficacy of these medications, have left rheumatology clinicians in a difficult position when considering when during a patient’s treatment course and in which patients, specifically, JAKi should be used. Two abstracts from ACR convergence 2024 further
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TNFis preventing cancer compared to placebo, and JAKi being neutral to placebo and maybe preventing haem cancers also. #ACR24 abstract 0989 was certainly provocative. I've shared my thoughts on @RheumNow https://t.co/yQFoUGifEN
Richard Conway @RichardPAConway( View Tweet )
Does vasculitis flare with checkpoint inhibitors?
@MDAndersonNews experience:
17 stable pts
4 pts flared - all able to be controlled
(i.e. 13 didn't flare)
Encouragement that stable vasculitis pts that need ICI should get them!
#ACR24 ABST1986 @RheumNow https://t.co/jO4w3HWBMd
David Liew @drdavidliew( View Tweet )
Study of 25K+ patients using TrinetX on immune checkpoint inhibitors shows no significant mortality difference between those with pre-existing autoimmune disease (AID) and those without.
Mortality rates:
AID: 39.8%
Non-AID: 40.2%
Large-scale evidence supports ICIs in AID… https://t.co/BI5jK9jsoM
Antoni Chan MD (Prof) @synovialjoints( View Tweet )
We know most preexisting autoimmune disease is very mangaeable when checkpoint inhibitors are needed.
So great to see that, in the VA, autoimmune disease pts largely haven't missed out on potentially lifesaving cancer immunotherapy.
Keep on reassuring!
#ACR24 ABST1985 @RheumNow https://t.co/ApOACBLi4K
David Liew @drdavidliew( View Tweet )
Always looking for cancer/CV signals from JAKi in big observational datasets w extensive JAKi use nationwide 🇯🇵 claims data RA pts n=52k (JAKi n=4.3k) Cancer with JAKi vs TNFi: aHR 2.2 (esp lung, lymphoma) This is a problem. Watch these data. #ACR24 ABST1336 @RheumNow #ACRBest https://t.co/vsnT46De6T
David Liew @drdavidliew( View Tweet )
Should you worry about giving TNFi to RA pts after a cancer diagnosis?
Medicare data with colorectal, lung, prostate Ca:
TNFi pts survival no worse (numerically better) than csDMARDs
Cancer pts deserve good RA treatment!
#ACR24 ABST0202 Suarez-Almazor @MDAndersonNews @RheumNow https://t.co/w58MNqRt1T
David Liew @drdavidliew( View Tweet )
ACR 2024 - Day 2 Report
Plenary sessions began the day, followed by thousands on the abstract floor. Here are a few of my favorite presentations from day 2 at ACR 2024.
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#Rheumatoid #arthritis is an independent risk factor for death in nonmetastatic clear cell renal ca !
👇N=32K, 802 w RA also
Caveats
immunotherapy Offered = in RA
Cancer specific mortality not affected
By #RA
Frailty & RA affected outcomes
#ACR24 @RheumNow @ACRheum #1327 https://t.co/rAQ57BPA19
Janet Pope @Janetbirdope( View Tweet )
Spicy network SRMA, 123pts w/JAK-TNF-PLBO
TNF >> JAK w/respect to malignancy (expected) & better than PLBO (spicy!)
JAK > PLBO for heme cancers (makes sense); no significant (but slight trend) toward PLBO > JAK for all cancer
The debate continues
#ACR24 @RheumNow Abstr#0989 https://t.co/tBnb02gyzF
Mike Putman @EBRheum( View Tweet )
Give a listen to my @RheumNow interview w Josh Hsieh, a rising star at #ACR24, who is presenting his first (of many) research project as a high school sophomore!
His work w @NamrataRheum explores what is known- & not yet known- for cancer survival in RA
https://t.co/boqwpP9CUK https://t.co/UQ37pyvZT6
Eric Dein @ericdeinmd( View Tweet )
Ab#474 #ACR24
Hsieh and @NamrataRheum
Cancer Survival in RA
Unable to do meta-analysis due to lack of data
HR for lung cancer in RA 1.04
No clear evid of increased risk, but more data and studies needed
Great research project by a high school student (!!)
@RheumNow https://t.co/Sfrf2v2UO4
Eric Dein @ericdeinmd( View Tweet )
Risk for atypical femoral fracture:
🚨Asian race - 4-6x higher risk
Duration of use is greater risk than older age
Higher risk when given for osteoporosis than cancer treatment
- Compare: osteonecrosis of jaw more common with cancer Rx
#ACR24 Review Course
@RheumNow https://t.co/V8cD5QWNGp
Eric Dein @ericdeinmd( View Tweet )
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