What should head-to-head studies in inflammatory arthritis teach us?
The multimillion dollar question for inflammatory arthritis prescriptions is: which drug should I use next?
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Late-Breaking Trials in axSpA and PsA
https://t.co/EWeF0nkb1h https://t.co/HgY0be0PDX
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 )
Marketscan claims study of 62,813 IMID women w/ 70,529 pregnancies & 69,412 births, 4,485 (7.1%) were exposed to at least one TNFi during pregnancy & 3,559 postpartum. TNFi use NOT assoc w/ SIE risk during Preg (HR 1.39; 0.95-2.05) or postpartum (HR 1.22; https://t.co/NsxOLpT0ds
Dr. John Cush @RheumNow( View Tweet )
ACR 2025 Rheumatology Round Up
Drs. Jack Cush & Arthur Kavanaugh, two of rheumatology’s most trusted voices, provide a breakdown of the latest breakthroughs and hottest topics in rheumatology from the 2025 ACR Convergence meeting in Chicago.
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What happens if you have #axSpA & concomitant #FM?
Pts with both have less TNFi retention,
-residual pain may lead to d/c Rx.
Need to determine if axSpA pt has #fibromyalgia as there may not be objective findings if no peripheral arthritis in axSpA.
#ACR25 @RheumNow abst#534
Janet Pope @Janetbirdope( View Tweet )
Excited about this target trial emulation in RA-ILD
Compared to RTX, NO significant difference in hospitalization/transplant/death for JAK, ABA, IL6 or TNF
Trends toward ABA and JAK looking better than RTX
Need trials for sure, but I like this project a lot
@RheumNow #ACR25 https://t.co/FQcphRvyHK
Links:
Mike Putman @EBRheum( View Tweet )
In a PsA cohort (n=1291), higher BMI was independently linked to lower odds of achieving MDA—especially in TNFi-treated patients. Impact was strongest in pain, skin, enthesitis, and PRO domains, not swollen joints. Each unit increase in BMI reduced MDA odds by 4–7%. Highlights https://t.co/TxO3HP51uk
Antoni Chan MD (Prof) @synovialjoints( View Tweet )
#2686 Using HR-pQCT, researchers tracked bone changes in RA & PsA. Seropositive RA showed worst bone density & microstructure, worsening with disease activity. TNFi, RTX & BARI improved MCP bone density, highlighting the impact of inflammation and treatment. @RheumNow #ACR25
Mrinalini Dey @DrMiniDey( View Tweet )
#2662
Using Medicare data to emulate real-world RA-ILD trials, investigators compared RTX vs ABA, TOC, JAKi & TNFi
No sig differences in mortality, resp, hospitalisation or lung transplant across groups, suggesting other b/tsDMARDs may be as safe as RTX for RAILD
@RheumNow #ACR25
Mrinalini Dey @DrMiniDey( View Tweet )
Biologic choice in PsA: consider factoring in obesity ⚖️
Abstract 2691: In a longitudinal cohort study, obesity associated with ↓ odds of achieving minimal disease activity (MDA) among pts on TNFi, but not with other DMARDs
@RheumNow #ACR25 https://t.co/p4KaH6HKYj
Akhil Sood MD, MS @AkhilSoodMD( View Tweet )
In a 5-year EHR-based cohort, PsO patients initiating IL-17i had significantly lower incidence of PsA/IA vs IL-23i, IL-12/23i, or TNFi. IL-17i reduced time with PsA/IA by 45% vs IL-23i, 61% vs IL-12/23i, and 74% vs TNFi. Further research need investigate if IL-17i may delay https://t.co/0PTbXZpLbu
Antoni Chan MD (Prof) @synovialjoints( View Tweet )
#ACR25 Clinical Preview by Prof Coates to be applied tomorrow!
Early Tx
Abstr#1677 First-line TNFi for 12-mth vs step-up = better outcomes at 5-Yr
Abstr#2662 Target emulation trial = No differences in hospitalization, death/transplant RTX vs TNFi, ABA, JAK, IL-6i @RheumNow https://t.co/yostJyc5T9
Links:
Md Yuzaiful Md Yusof @Yuz6Yusof( View Tweet )
#ACR25 Clinical Review by Prof Coates @DrLauraCoates to be applied tomorrow!
Early Diagnosis/Tx
Abstr#2689 EHR study = IL-17i could prevent #PsA vs IL-23/TNFi
Abstr#576 Oligo → Polyarthritis progression in women, no DMARD, enthesitis, dactylitis, nail psoriasis @RheumNow https://t.co/e1hCERpCNW
Links:
Md Yuzaiful Md Yusof @Yuz6Yusof( View Tweet )
Clinical Year in Preview
SpA: no difference in efficacy rotating vs switching bDMARD MoA for next steps
@RheumNow #ACR25 #LB09 https://t.co/shCLgk7Yqz
Jiha Lee @JihaRheum( View Tweet )
Do biologics prevent PsA?
Retro cohort analysis EHR through natural language processing
5 years trends
PsO treated w/ IL-17i had lower incidence of PsA/IA than pts treated w/ IL-23i, IL-12/23i, or TNFi therapies
Adjustment on several confounding
Prospective data heavily https://t.co/W9MFaWNbWC
Aurelie Najm @AurelieRheumo( View Tweet )
In a U.S. axSpA cohort (n=4,799), women had a 24% higher adjusted risk of TNFi discontinuation vs men especially under age 65. No sex differences seen for IL-17i or JAKi, though sample sizes were small. Highlights need for sex-informed treatment strategies. Abstract#2634 https://t.co/58Dw3nFCsf
Antoni Chan MD (Prof) @synovialjoints( View Tweet )
Secukinumab vs Ustekinumab in PsA https://t.co/EylYHtRWsj
@synovialjoints Elaborate more on head to head trial in PsA , in a population who failed TNF biologic.
@RheumNow
#ACR25
Nouf Al hemmadi @NoufAhmedAlham2( View Tweet )
Sex differences in 💊 d/c in axSpA from the RISE registry
🔅Females - ⬆️discontinuation risks for TNFi
🔅No sex differences seen in dc risks for IL17i and JAKis
🔅Young females discontinued faster than males
Gender diff in SpA can guide tx decisions
#ACR25 @RheumNow Abs2634 https://t.co/kcXfZrU4zI
Links:
sheila @RHEUMarampa( View Tweet )
Head to head study of Secukinumab vs Ustekinumab. In TNFi-experienced PsA patients, the AgAIN trial shows secukinumab performed better than ustekinumab in HAQ-DI response (57.1% vs 27.0%, p=0.002) and across all endpoints (joint counts, pain, and skin outcomes). Fewer https://t.co/CDCWkLF5TW
Antoni Chan MD (Prof) @synovialjoints( View Tweet )
52wks data of IZOKIPEB affibody IL17Ai RCT 2b/3 PsA
Primary ACR 50 16wks
Crossover 52 wks IZO 160 Q2W, IZO 160 QW, PBO-> IZO 160 QW
ACR50 50% 57% 51%
ACR70 36% 42% 42%
PASI100 55% 64% 58%
MDA 47% 52% 47%
No specific enthesitis data presented
No new safety signal
Next https://t.co/J18rSTmyze
Aurelie Najm @AurelieRheumo( View Tweet )
In PsA, a predictive model using routine labs (NLR, LMR, ESR, C3, baseline DAPSA) identified TNFi responders with 100% sensitivity and 0.861 AUC. Supports biomarker-driven personalization of PsA treatment. Abstract#2371 @RheumNow #ACR25 https://t.co/lojQFfWsJi
Antoni Chan MD (Prof) @synovialjoints( View Tweet )
ROC-SpA study assessed whether changing to an IL-17Ai was superior to rotating to a 2nd TNFi in axSpA pts who failed on a 1st TNFi
At wk 24, no significant diff in ASAS40 rates bet the 2 groups
IL-17Ai not superior to a 2nd TNFi
Rotate or change?
#ACR25 @Rheumnow AbsLB09 https://t.co/4EtNEFTSN9
sheila @RHEUMarampa( View Tweet )
When every option fails, bold moves remain.
In 5 multi-resistant RA pts, TNFi + JAKi combo brought remission in most without major AEs.
Not standard, not risk-free, but in young, low-infection-risk pts, it may offer a path forward.
@RheumNow #ACR25 Abstract#2272
Jiha Lee @JihaRheum( View Tweet )
Gladman et al. PsA patients treated with guselkumab in DISCOVER-2. Male patients had more radiographic progression. Males exhibit stronger relationship between early joint response and lower subsequent rates radiographic progression. @RheumNow #ACR25 Abstr#2345 https://t.co/TSNwesvPzj
Richard Conway @RichardPAConway( View Tweet )
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