Thread by @rheum_cat

Dr Carol Langford for the clinical #YearInReview #ACR22

1⃣GLORIA pragmatic trial in RA >= 65 yrs, of add on low dose prednisolone

pubmed.ncbi.nlm.nih.gov/35641125/

NNH 9.5

#ACR22

How to weigh benefits and harms in GLORIA?

👉The protocol of this study provides tips to interpret the findings

#ACR22

2⃣We've all read ORAL Surveillance, the phase 4 RCT on tofacitinib vs TNFi in RA with CV risks

Outcomes: MACE, malignancy

#ACR22

pubmed.ncbi.nlm.nih.gov/35081280/

Co primary endpoint, non inferiority not met

Higher incidence of MACE, cancer in the >=65 subgroup

#ACR22

What about those with h/o ASCVD?

NNH 16 for 1 MACE event with TOFA

pubmed.ncbi.nlm.nih.gov/36137735/

#ACR22

Reminder of JAK inhibitors, MoA, and questions about toxicities.

Class effects? FDA put black box warning on all JAK inhibitors based on TOFA data

#ACR22

Besides RA, JAK inhibitors have been added to the armamentarium to #axSpA and #PsA

#ACR22

3⃣#gout! MIRROR RCT - PO MTX vs pbo to reduce Abs to pegloticase

pubmed.ncbi.nlm.nih.gov/36099211/

Benefits: improved gout control & safer pegloticase use
Harms: MTX SEs

#ACR22

4⃣ @docrota IVIG for dermatomyositis in @NEJM

pubmed.ncbi.nlm.nih.gov/36198179/

Cautions: cost, thromboembolic risk

#ACR22

@docrota @NEJM 5⃣CAR-T for refractory #SLE

pubmed.ncbi.nlm.nih.gov/36109639/

Note the risks esp cytokine release syndrome

#ACR22

@docrota @NEJM How does this work?

Ultimately CAR-T cell binds B19 on B cell leading to B cell lysis and depletion

#ACR22

@docrota @NEJM n=5 refractory SLE pts

1 needed tocilizumab for cytokine release syndrome

need longer f/u to see if remission persists

#ACR22

@docrota @NEJM A turning point for SLE targeted therapies

one of these: obinutuzumab (CD10 inhibition) pubmed.ncbi.nlm.nih.gov/34615636/

#ACR22

@docrota @NEJM 6⃣tocilizumab for PMR (GC dependent)

pubmed.ncbi.nlm.nih.gov/36125471/

BTW IV toci FDA approved for GCA earlier this year

#ACR22

@docrota @NEJM 8⃣it's us!! @rheum_covid @RichardPAConway @HsiehEvelyn @MaxKonigMD

pubmed.ncbi.nlm.nih.gov/34807517/

#ACR22

@docrota @NEJM @rheum_covid @RichardPAConway @HsiehEvelyn @MaxKonigMD 9⃣ A turning point for pts on immunosuppression was the advent of evusheld

Original @NEJM didn't really study our population of interest

Enter the Israel data pubmed.ncbi.nlm.nih.gov/35904210/

#ACR22

@docrota @NEJM @rheum_covid @RichardPAConway @HsiehEvelyn @MaxKonigMD FDA on Evusheld, last updated end of October 2022

fda.gov/media/154703/d…

#ACR22