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JAK/TYK2

RA: One JAK to Rule Them All? Dr. Brian Jaros reports on abstract 1362, presented at #ACR24. https://t.co/QChMyma3Y2 https://t.co/qq3BqpT2Gh

Dr. John Cush @RheumNow( View Tweet )

JAKi in inflammatory myositis? #ACR24 will showcase nearly 3000 abstracts. With the expanding use of JAK inhibitors, there will be some interesting presentations for off label use. There have been some uncontrolled data that tofacitinib reduced inflammatory myositis disease… https://t.co/SnqvElwk0B https://t.co/A5mJbpmB5P

Dr. John Cush @RheumNow( View Tweet )
ACR24 take homes ➡️#Inflammatory #myositis #Upadacitinib improved MDA5 ILD #Baricitinib 4mg/d good in myositis delayed start #RCT #Tofacitinb ➡️help for skin, calcinosis, rash in case series ➡️RCT ongoing JAKi is ‘jacked’ in muscles 💪🏿 #ACR24 @RheumNow @ACRheum 1731 0348

Janet Pope @Janetbirdope( View Tweet )

SELECT-GCA suggests JAKis may be the new kid on the block Clinicians treating giant cell arteritis (GCA) have long had to contend with a disappointingly limited selection of drugs from which to select. https://t.co/vtJzwFZMBq https://t.co/dikMRwjIZY
Dr. John Cush @RheumNow( 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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#MDA5 #dermatomyositis assoc #ILD May do better w #tofacitinib vs #CNI in 515 pts Too bad they didn’t do a pragmatic RCT as we do t know the reasons for prescribing each #Rx But impressive survival w #tofa #ACR24 @ACRheum @RheumNow abst1736 https://t.co/HLJknSYcNJ
Janet Pope @Janetbirdope( View Tweet )
JAK-pot! How fast do DMARDs work? Dr. Mike Putman interviews Dr. Kim Lauper about abstract 0501, How Fast Do JAK-inhibitors, TNF-inhibitors, Abatacept and IL-6 Inhibitors Act in Rheumatoid Arthritis? An International Collaboration of Registers of Rheumatoid Arthritis Patients… https://t.co/GO9EwyrVpV https://t.co/lELE5SJW5i
Dr. John Cush @RheumNow( View Tweet )

JAKs and Other Drugs in PMR

This has been an interesting ACR meeting in terms of PMR updates. I would argue that we are still far too wedded to glucocorticoids only in the management of PMR. Yes, some patients will do fine with just glucocorticoids but we persist far too long with a glucocorticoid only strategy in others

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I've shared some thoughts on @RheumNow on methotrexate, tocilizumab, and baricitinib in PMR based on #ACR24 https://t.co/WXiW1nLN4k

Richard Conway @RichardPAConway( View Tweet )

A#2583 Apremilast for axial inflamm in PsA, assess by CANDEN MRI scoring MOSAIC P4 open label trial Reduction in inflammation seen in vertebral bodies & posteriolateral, not in facet joints No changes in SPARCC SIJ, spine - though low baseline SIJ inflammation @RheumNow #ACR24 https://t.co/3GKEGJbtdc
Eric Dein @ericdeinmd( View Tweet )
A#2584 Mease Zasocitinib TAK-279 - potent, selective TYK2i P2b, 12w PsA RCT 15/30 mg - similar response, better than PBO for ACR20/50/70, MDA, DAPSA, PASDAS 29% MDA v 13% PBO Safety no signal for MACE, cancer, serious ifn, death. Mild acne signal noted @RheumNow #ACR24 https://t.co/1eqD9R5fLe
Eric Dein @ericdeinmd( View Tweet )

Selective TYK2i zasocitinib, results of Phase 2 DBRCT Dose dependent improvements in various PsA outcomes; NNT~5 for DAS28 remission, NNT~20 for PASDAS Hard to compare to current agents, somewhere between JAKs (woot!) & "apremlist zone" 🫣 #ACR24 @RheumNow Abstr#2584 #ACRbest https://t.co/t0y6C618ll

Mike Putman @EBRheum( View Tweet )
A#2586 EBIO study - secukinumab on entheseal bx in PsA. Compare b/l to 3+ mo on SEC Biopsy: change of entheseal cell composition on IL-17A Rx - decr Il-17A producing cells in responding pts Spatial transcriptomics - colocalizarjon of ILC2, CD200+ fibroblasts @RheumNow #ACR24 https://t.co/kMiqpBRxuE
Eric Dein @ericdeinmd( View Tweet )
Triboulet et al. JAKi in RA-ILD. 42 patients. Stability of PFTs over median 21 months. HRCT stable in 62%. Progressive ILD on HRCT in 19%. @RheumNow #ACR24 Abstr#2249 https://t.co/PY9BrCfNHc https://t.co/r8fIgrjyDu
Richard Conway @RichardPAConway( View Tweet )
Early observational data suggesting JAK inhibitors can play a role in TAK tx We have seen this with UPA in GCA this conference… time for SELECT-TAK ! @RheumNow #ACR24 https://t.co/B2Wa8sOFTp
Brian Jaros, MD @Dr_Brian_MD( View Tweet )
Lots of data on TYKs including much supporting efficacy in interferon inhibition Can we really call interferon signalling a "central" pathway in SLE? Inhibiting it has been modestly successful, at best, and mostly for skin dx #ACR24 @RheumNow Abstr#2434 https://t.co/Q94FQz3gzO
Mike Putman @EBRheum( View Tweet )

ORAL Surveillance - Is Statin Use the Problem/Solution?

The findings from ORAL Surveillance Study have been a dominant conversation at recent ACR Convergence, with the seminal findings and subsequent analyses a target of debate. Subsequent post-hoc analyses, follow-up studies, and claims data analyses have been used to further interpret the data,

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ACR 2024: What Exactly do JAKs and TYKs Do?

Let me start by confessing something embarrassing: the immune system is just too complex for me to understand. I suspect the onslaught of new drugs with new mechanisms at ACR 2024 may have left many of you feeling similarly. This may be particularly true for the TYK/JAK/STAT signaling pathway,

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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 )
Upadacitinib in Behcet's disease - would be very much welcomed, and this open label 8 patient pilot from China is encouraging. We saw similar data for tofacitinib before @ARD_BMJ: https://t.co/YlAQVXpnTY JAKi (?generic) could be a fantastic option! #ACR24 ABST2515 @RheumNow https://t.co/65friNLUOK
David Liew @drdavidliew( View Tweet )
Here's a meta-analysis of MACE/malignancy in JAKi vs TNFi in observational cohort studies. All the epidemiological challenges here aside, it's a good reminder that with ORAL Surveillance it's *cardiovascular risk enriched pts* we're concerned about. #ACR24 ABST2264 @RheumNow https://t.co/vIXlrI3V2d
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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We saw evidence for JAK use in GCA this conference... what about IL-1 inhibition? Double-blind RCT: Anakinra vs. PBO w/ similar GC taper in GCA pt NO difference in relapse rate at 26, 52 wks despite addition of Anakinra @RheumNow #ACR24 Abst1699 https://t.co/gUb0gGJjTG
Brian Jaros, MD @Dr_Brian_MD( View Tweet )

Super helpful results from COVER study, holding JAK or IL17 for COVID boosters Antibody titers went up regardless of holding Holding caused flares (14-25% increase!) Pretty clear message; continue JAK / IL17 #ACR24 @RheumNow Abstr#1718 #ACRbest https://t.co/Mf89dWrRWz

Mike Putman @EBRheum( View Tweet )

JAKi in inflammatory myositis?

Abstract 1731 is a small RCT of baricitinib in inflammatory myositis comparing early start baricitinib to later start.

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