Phase 2 efficacy and safety of deucravaticinib (TYK2i) in mod-severe SLE. Met primary endpoint (SRI4) for 3mg and 6mg doses (but not 12mg). No signal for HZ but increased oral herpes. Bigger numbers will be helpful.

Dr. John Cush #ACR22 #plenary #ACRBest

Clinical Pearl at #ACR21 from Dr. J. Stone:

⭐️Tissue biopsy is not essential in diagnosing IgG4-related dz in a pt w/ a typical pattern of retroperitoneal fibrosis.

⭐️Periaortitis ('coated' aorta) w/ 'hairy' kidney is NOT IgG4 but rather Erdheim-Chester Dz

#ACRBest @Rheumnow

HCQ does not prevent RA in CCP+ pts w/out clinical arthritis!

Stop RA: RCT HCQ vs. PBO in pts at-risk

Interim analysis 140+ pts
RA development HCQ 34% vs. PBO 36%

Trial interrupted as met futility criteria.

bit.ly/3TyjiLI

Abs#1604 #ACR22 Dr. John Cush #ACRBest

ICYMI: #ACR21 Best Abstracts We Saw - Day 3 (Monday)

The third day of ACR 2021 took a big leap in online content. We share compilation (with links) of presentations were the “ACRBest” as seen by our RheumNow faculty.

bit.ly/3DlL0Ek rheumnow.com/news/acr21-bes…

In their cohort, Dr. Jorge reports that SLE pts who used SGLT2i had⬇️risk of MACE(HR 0.69 [95% CI 0.48-0.99]) & renal progression(HR 0.71 [95% CI 0.51-0.98]) vs DPP4 use
Risk of MACE also⬇️in LN subgrp
🧐💊A potential role of SGLT2i for SLE/LN?
#ACR23 ABST1579 Dr. John Cush #ACRbest

How do we treat #VEXAS - UBA1 mutation
Large multicenter cohort - 110 pts, 99% M
Confirms the benefit of JAKi and tocilizumab
Others not so much
Dr. John Cush #ACR23 #ACRBest
#abstL03

There is a dose, duration and recency-dependent relationship between previous GC use and MACE. GC doses 5mg/day, durations of 30 days, and use one year prior to MACE were all associated with an increased risk of MACE, Wallace B Abst#2430 #ACR23 #ACRBest bit.ly/3tHZ5vZ

🌟Subclinical GCA in PMR🌟

👉25pts PMR
👉US of TA and AX arteries

💥5(20%) US evidence of GCA (TA in 5/5, AX in 1/5)
💥1yr f/up -all 5 developed clinical GCA

❓Time to rethink our assessment of PMR pts ❓

Abst#0478
#ACR22 Dr. John Cush Colm Kirby
#ACRbest

BIOBADASER cohort showing risk of incident cancer in rheumatic disease and previous malignancy was not difference between TNFi and other biologics/tsDMARDs. Need bigger numbers (esp with JAKi) to really reassure.

Dr. John Cush ABST0267 #ACR22 #ACRBest

tinyurl.com/2e3jmnr4

Ab1117 #ACR22 Deucravacitinib: TYK2 inhibitor in active SLE?
363 pt P2, double-blind PBO-controlled 48 wk study
DEUC 3 mg BID, 6 BID, 12 QB vs PBO:
At 32wk: DEUC 3BID & 6BID > PBO, sustained across all groups at 48wk.
AEs: similar bw PBO and DEUC. No VTE
Dr. John Cush #ACRBest

Low dose #glucocorticoids in rheumatic diseases can lower bone mass and increase # even 2.5 mg #prednisone . The change in #BMD was more predictive of fracture not absolute BMD. L01 #ACR22 #ACRBest Dr. John Cush

Get the skinny on Bimmy! Gotta learn this name #Bimekizumab in bio naive PsA N=852 Bimmy=IL17 A & F inhibitor Great data on skin & joints. Where will it fit in as we have other IL17Ai’s is IL17F giving added value? #ACR22 #ACRBest Dr. John Cush

Why are #sJIA pts prone to #MAS ?
Potential new treatment target mTORC1?
mTORC1 gene signature in monocytes
Mice models and human translational studies with evidence
#ACRBest #ACR22 @rheumnow abst#0004 #stillsdisease #autoinflammatorydisease

Wallace et al. Dose, duration, recency dependent relationship between GC and MACE. Even 5mg/day, 30 day use, and use 1 year prior associated with risk. 5mg, 7.5mg, 10mg pred for 90 days - 13%, 19%, 27% MACE increase Abstr#2430 #ACR23 #ACRbest
bit.ly/4aFh32X

ABS0164 @ #ACR23

Is a virtual MSK test consistent & comparable to in-person assessments w/ regard to dz activity in f/u of RA pts?

YES!
Some variability in # of swollen joints but approach shown below had good reliability & acceptable lvl of agreement

Dr. John Cush #ACRBEST

#ACR22 Abstr#L07 Most impressive Delta difference vs Control in #lupus ! In Phase 3 RCT in China, more patients in Telitacicept, BAFF/APRIL-i met SRI-4 (delta 44% if data imputed; 34% without). No major safety. Phase 3 in US is in progress. Would be historic! Dr. John Cush #ACRBest

Baker et al. Optum database study. Tofa assoc reduced incident RA-ILD. aHR 0.33 (vs ADA) Dr. John Cush #ACR22 Abstr#2251 #ACRbest acrabstracts.org/abstract/reduc…

Excellent pragmatic RCT, TNF withdrawal in RA

Almost 2/3 flared by 1 yr; at 3 years up to 3 in 4

Supports my practice of generally continuing TNFs long term

Also highlights importance of pt preferences; 1 in 4 may do well if they wish to discontinue

Dr. John Cush #ACR23 #ACRBest

What imaging modality is best in GCA?

Dutch study: n=42
?GCA got all three of USS, PET/CT, MRI

Overall performance basically the same between all three.

Important details in 🧵
but reasonable to say you can be happy with whatever you’ve got!

ABST1617 #ACR22 #ACRBest Dr. John Cush

Ab1673 #ACR22 : Time-to-Conception (T2C) in SpA
Prosp, observ
88F, 56 pregnancy
Subfertility in 45% F, T2C 16 mos
Risks: age, NSAID
Rx: NSAIDs (26%), steroids (9%), csDMARD (14%), biol (69%)
No control grp - Is it cause or correlate?
2020 Repro G/L rec d/c NSAID
Dr. John Cush #ACRBest