Serious infections w/ adalimumab. Marketscan MarketScan claims study (1/17-12/20) of ADA Rx in Hidradenitis Supprativa (n 1650) or psoriasis(8699). Risk of SIE & hospitalization greater w/ HS (HR 1.53); esp for sepsis & GU infxn https://t.co/2qa7O2v6fm
Dr. John Cush @RheumNow( View Tweet )
Australian Vaccine study (2019 - 2021) - w/in 12 mos of b/tsDMARD initiation 73% (11,225/15,460) recv influenza vaccination. High-dose Flu vax used in 28% in 60–69 yo, but > 80% older than 70yo. Only 9.7% recv pneumococcal & 2.4% zoster Zostavax or Shingrix) vax w/in 6 months of https://t.co/xoGTWMUi1L
Dr. John Cush @RheumNow( View Tweet )
In 2024, 77 pts referred to Rheum for possible PMR were ultimately Dx w/ B19 viral infx. 96% had arthralgia & 7% had PMR-like features (5/5 w/ BL shoulder/neck. prolonged AM stiff, fever & Hi CRP/ESR - none had hip pain. 4/5 were male, w/ mean age of 55 yrs. None were RF/CCP+ https://t.co/SsLVEyL8X8
Dr. John Cush @RheumNow( View Tweet )
Having #RA does not increase mortality in CA pts Rx w/ immune checkpoint inhibitors (ICI). 301 Veterans w/ RA & 2114 nonRA controls were compared: all-cause mortality was similar (HR 1.09; 0.94, 1.25). Most deaths from cancer (90% & 91%), but rarely from infection (<1%) https://t.co/gsXie6HpTu
Dr. John Cush @RheumNow( View Tweet )
Western Australia study of 1854 SLE pts (median 40 yrs old). Interstitial lung disease was seen in in 3.8% of SLE, 26 fold more than controls. Risk factors for ILD included older age, smoking and serositis. SLE-ILD pts had higher mortality rates (MR 52.0, CI 37.0–71.1).
Dr. John Cush @RheumNow( View Tweet )
Biologic use in 5008 IBD pts finds higher serious infxn (SIE) rates (vs, RA or PsO). In UC the SIE rate was 5.5/100PY w/ vedolizumab & 7/100PY w/ other biologics. In Crohns the SIE rate was 7.9/100PY w/ vedolizumab vs 6.5/100PY w/ other biologics (adj HR 1.15; 0.95–1.40) (P .16) https://t.co/R7YC220NnO
Dr. John Cush @RheumNow( View Tweet )
Systematic review of 10 studies showed TNFi exposure in utero not assoc w/ incr risk of infant severe infxn (4 RCTs); same for breast milk exposure (2 RCTs).
Infant vaccination outcomes unaffected by TNFi use, but rec delaying BCG vaccination if TNFi exposed https://t.co/02Nn6TuzR3
Dr. John Cush @RheumNow( View Tweet )
In 2024, 77 pts referred to Rheum for possible PMR were ultimately Dx w/ B19 viral infx. 96% had arthralgia & 7% had PMR-like features (5/5 w/ BL shoulder/neck. prolonged AM stiff, fever & Hi CRP/ESR - none had hip pain. 4/5 were male, w/ mean age of 55 yrs. None were RF/CCP+ https://t.co/AiK2K9whBH
Dr. John Cush @RheumNow( View Tweet )
Hospitalization in Stills: Is it "Still" an infection?
Dr. Janet Pope discusses abstract 0163, "Trends in hospitalization and outcomes among patients admitted with Adult-onset Still’s disease in the United States: INSIGHTS FROM THE NATIONAL INPATIENT SAMPLE (2016-2022)," https://t.co/3Z0U9XN3nx
Dr. John Cush @RheumNow( View Tweet )
Why are vaccine Abs maintained after CAR-T
-depletion of pathogenic #Abs are dampened/eliminated
Clonal repetoire expansion
Remission=naive B cell pop'n
Reset immune system sparing memory cells
vs ?not all pathogenic cells eliminated in tissue
#ACR25 @RheumNow @ACRheum
#26S21 https://t.co/jb3dD5Ssip
Janet Pope @Janetbirdope( View Tweet )
Another toxicity signal to watch in the CAR T space: LICATs
Abstract 1537 reports a new immune-related toxicity distinct from CRS or ICANS:
🔹Affects organs prev involved in autoimmune dx: skin (35%) and kidneys (22%)
🔹Mostly mild (Grade 1–2); 3 cases Grade 3
@RheumNow #ACR25 https://t.co/mtZh47nWtv
Akhil Sood MD, MS @AkhilSoodMD( View Tweet )
CAR-T toxicity in hematology
(the things we have to look out for in rheumatology, as application of CAR-T potentially broadens)
@andrew02114 @MGHCancerCenter with the heme-onc point of view in the #ACR25 BCRC @RheumNow https://t.co/1YjadL7LCF
Links:
David Liew @drdavidliew( View Tweet )
Post-CAR-T myelopathy has been an issue in heme onc, and is still an unpredictable quantity without a clear cause. Will this be a problem for autoimmune CAR-T as we gain more experience? @CarolineDiorio @ChildrensPhila in the #ACR25 BCRC pre-meeting @RheumNow https://t.co/RhhdOiyEAX
Links:
David Liew @drdavidliew( View Tweet )
#2682 In a randomised trial of 320 RA patients, the recombinant zoster vaccine (RZV) was safe and did not trigger disease flares. But methotrexate use and older age significantly blunted antibody responses ➡️key factors to consider for vaccine strategies in RA. @RheumNow #ACR25
Mrinalini Dey @DrMiniDey( View Tweet )
Observational study from VCRC AAV patinet, >70% had pulm involvement at some point
As expected, nodules favor GPA (63% vs 12% MPA) & DAH favors MPA (61% vs 31%)
More ILD in MPA (11% vs 1%) & more endobronchial in GPA (12% vs 2%)
Helpful pearls!
@RheumNow #ACR25 Abstr#0721 https://t.co/Iu5MdiTABR
Mike Putman @EBRheum( View Tweet )
Cohort study comparing 3yr safety outcomes of JAKi vs. TNFi in AS pts
JAKi use: ⬆️incidence of HZ infxn but not significant; ⬆️all-cause mortality (HR 4.94) and GI bleed (p=0.04)
Individualize tx. consider potential complications
#ACR25 @RheumNow Abs2633 https://t.co/pjKAazQFwW
Links:
sheila @RHEUMarampa( View Tweet )
Lung Disease in ANCA-associated Vasculitis
Dr. Mike Putman discusses abstract 0721, "Pulmonary Manifestations of Granulomatosis with Polyangiitis and Microscopic Polyangiitis", presented at #ACR25.
https://t.co/A5uKT4jG1I https://t.co/7E4k7QdiNK
Links:
Dr. John Cush @RheumNow( View Tweet )
In a retrospective TrinetX analysis of 3 year safety outcome in AS, JAKi use was linked to higher mortality and GI bleeding vs TNFi, but lower malignancy risk. Infection rates were similar, with a trend toward more herpes zoster in JAKi users. Abstract#2633 @RheumNow #ACR25 https://t.co/pPY0wpAKA3
Antoni Chan MD (Prof) @synovialjoints( View Tweet )
Adverse events from avacopan the WHO pharmacovigilence database (VigiBase)
Not a lot new - infections happen, hepatic events happen but seem to be somewhat rare
Pharmacovigilence is hard; most events go unreported & we often have the classic "denominator problem" (ie we saw https://t.co/28tYkXv0Lz
Mike Putman @EBRheum( View Tweet )
Infection vs steroid sparing in PMR/GCA/AAV studies with steroid-sparing Rx
GiACTA (1, top right) aside,
- low infection rates
- the more steroid saved, the less the infection risk
Infection risk in vasculitis is driven by steroid, not DMARD
#ACR25 ABST2526 @RheumNow https://t.co/UprbxUQyQC
David Liew @drdavidliew( View Tweet )
#ACR25 How hard will you go & at what cost? A study in China using CD20/BCMA Bispecific autologous CAR-T showed profound depletion, normalisation of abs and good response in #SLE (10/11 had LN). But 2 had G3 infections & cytopenia. Presenters said some had IVIG @RheumNow #ACRBest https://t.co/TF0wpib5rr
Links:
Md Yuzaiful Md Yusof @Yuz6Yusof( View Tweet )
#1747 Serious infections ~2× more common in RA-LD, esp RA-ILD. Pulmonary, bacterial, viral & fungal infections all increased, underscoring need for tailored prevention and vaccination. @RheumNow #ACR25 https://t.co/soyzqLk7Vj
Mrinalini Dey @DrMiniDey( View Tweet )
#ACR25 Abstr#LB02 Is there a role for JAK-i for the treatment of IgG4-RD? Opel label RCT in China (N=58) showed NO relapse in Tofacitinib + GC taper vs GC Taper alone (54%). No serious infection. Interesting and a PBO-controlled is warranted @RheumNow https://t.co/dFvAmcGfCT
Md Yuzaiful Md Yusof @Yuz6Yusof( View Tweet )
EGPA relapse in MANDARA including OLE
Majority of relapses are asthma / sinonasal in nature
Of non-airway:
- arthralgia/myalgia
- sensory peripheral neuropathy
@RheumNow #ACR25 Abst1769 https://t.co/cPjjzl4RWS
Links:
Brian Jaros, MD @Dr_Brian_MD( View Tweet )
MSK side effects of CAR-T, based on FAERS pharmacovigilance data (also see @DrGomezPuerta in @seminarthrheum https://t.co/LnwjU5aebs) #ACR25 ABST1731 @RheumNow https://t.co/kREEy3HLE9
Links:
David Liew @drdavidliew( View Tweet )
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