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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
We worried that JAKi + MTX might impair Shingrix efficacy, esp given JAKi HZ risk Shingrix nested in upa RCT: Response (seroconversion rate, titres, cellular response) less than gen pop, but still very good + only 2/95 had RA flares Vaccinate away! OP0225 #EULAR2023 @RheumNow
#EULAR2023 #POS1133 Consistent with clinical response in Phase 2 RCT, therapy with Updacitinib alone and ABV599-HD (Elsubrutinib + Upadacitinib) modulated IFN-I signalling pathways (IFN gene expression & proteomics). Assuring therapeutic evidence @RheumNowNews
Can’t escape ORAL Surveillance RCT talk Lots of real world data on CV risk & JAKi here (with all the selection, measurement bias) First up: multinational JAK-pot study (n=>50k) Even if you mirror the high-risk RCT cohort - not much there for MACE OP0219 #EULAR2023 @RheumNow
JAKi use did not increase CV risk compared to TNF, no difference between Bari and Tofa, non significant increased IRR in patients >65 years, Merel Opdam, Abst#OP0221 #EULAR2023 @RheumNow
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
The JAK-pot study did not show any significant differences in MACE and other CV outcomes in RA patients treated with JAKi, slight increase signal in VTE/PE, Romain Aymon, Abst#OP0219 #EULAR2023 @RheumNow

The future of lupus treatment is oral therapies?

There has been an explosion of trials in SLE, including nonrenal and glomerulonephritis studies. But, what about the JAKis and Tyk2 oral drugs in SLE?

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#EULAR2023 #POS0112 Consistent with clinical response, Post-hoc analyses of Phase 2 RCT of Deucravacitinib (Tyk2-i) showed this therapy suppressed both IFN and B cell pathways - a broader mode of action in reducing #SLE pathophysiology. Look forward to Phase 3 results @RheumNow
JAK inhibitors have been effective in refractory inflammatory myositis, all open label, but no controlled trials. #EULAR2023
RheumNow’s expanded coverage of the #EULAR2023 annual meeting is sponsored in part by Bristol Myers Squibb. All content is chosen by RheumNow and its Faculty.
I’ve been hearing the term ´Jackies’ used in talks on Jak inhibitors. A shorter form of JAKinibs or JAKi #EULAR2023 @RheumNow
Don’t be ‘rash’, get adult immune compromised Pts vaccinated against #shingles #varicella #zoster K Winthrop has research re #HZ #vaccination with #Shingrix in #Upadacitinib at #EULAR2023 #OP0225 Bottom line-get #immunecompromised Pts with #rheumatoidarthritis jabbed! @RheumNow
JAKi have superior effectiveness at 6 months compared to TNFi and the efficacy was similar in those with and and without safety risk (increased age, CV risk, smoker) by Hannah Bower, Abst#0133 #EULAR2023 @RheumNow
The overall risk of cancer and cardiovascular disease were decreased in RA treated with JAKi but there was no comparison with TNFi, Sung Soo Ahn, Abst#00132 #EULAR2023 @RheumNow
#EULAR2023 #OP0139 Should we aim for dual blockade in #lupus? A Phase 2 RCT showed more patients on ABBV-599 HD (elsubrutinib (BTK-i) + Upadacitinib (JAK-i)) and UPA monotherapy met primary & secondary endpoints vs Placebo at 48Wks. No major malignancy or VTE concerns @RheumNow
JAKi are NOT associated w worse safety vs bDMARDs when adjusting for confounding. Did regulators get it wrong? #EULAR2023 @RheumNow #OP0116
#JAKi May decrease #cancers - age, male, #diabetes had more #cancer but NOT associated w drug prescribed AND LESS #malignancy & LESS #CVE in JAKi vs csDMARDs in huge admin database. Diff from other results OP0140 @RheumNow #EULAR2023 EFFECTIVE Rx of RA LOWERS CVE & cancer w JAKi!

Promising new therapies in SLE

The pharmacology treatment in SLE is a rapidly expanding field of research that provides excitement and optimism to both the patients and the clinicians. We now have three licensed targeted therapies (belimumab and voclosporin in active lupus nephritis and anifrolumab in non-renal SLE) over the

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An update on JAK inhibitors and cardiovascular risks

May 31, 2023

In the last 2 years, there has been more caution and vigilance with the use of JAK inhibitors in the treatment of rheumatoid arthritis due to the risk of CV events, including MACE and VTE. The ORAL surveillance study, a post-approval safety study conducted in RA patients aged ≥50 years with ≥1

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Metanalysis of 62 RCTs, 16 LTEs, 82 366 Pt-Yrs JAK exposure. JAKi malignancy incid rate = 1.15/100 PYs in RCTs (1.26/100PYs overall). Network meta-analyses show no diff betw JAK & PBO or MTX in NMSC, but signif increased malignancy risk (IRR 1.50)
RheumNow’s expanded coverage of the #EULAR2023 annual meeting is sponsored in part by Bristol Myers Squibb. All content is chosen by RheumNow and its faculty.
#EULAR2023 #OP0053 Baricitinib in non-renal #lupus were inconclusive. How about Renal #SLE?An RCT showed primary endpoint (=>50% reduction in proteinuria) was met more in Bari vs Cyclo at Wks12 & 24. Intriguing but need longer-term, composite endpoint and larger size! @RheumNow
EULAR PtoC management of targeted therapies in pts w/ IA & Hx cancer 1) If remission, initiate targeted therapy w/out delay 2) Prefer anti-cytokine bDMARDs if Hx solid cancer 3) B cell depleting therapy if Hx lymphoma 4) Use JAK inhibitors and abatacept with caution 🛑
New benefit/risk outlook 👀 on ORAL surveillance 2 subgrps: 🟢RA w/ no previous Hx of atherosclerotic CV dis = TOFA at least as good as TNFi AND risk of MACE is comparable 🛑RA w/ HxASCVD = efficacy TOFA = TNFi AND > risk of MACE OP0043 #EULAR23 @Rheumnow