This morning, to end the ACR 2016 meeting, Dr. Cush and Dr. Kavanaugh, fan favourites in Canada, did their annual meeting round up in an informal style: sitting with their laptops and chatting back and forth about their picks from this meeting. Love their comedic style including jokes about the two of them running for ACR president to "Make the ACR great again."
I will summarize their top picks, some of which you have had read about in detail here on this space already.
1. Late breaker yesterday presented by Dr. Deodhar on guselkumab in PsA. It looks very good for skin and good for joints, so a promising new molecule and another choice for PsA.
2. Abstract #1725, apremilast plus biologic as presented by a practitioner. Artie and Jack gave kudos to the author for this real-world experience but they were sceptical of the utility due primarily to the cost.
3. Abstract #1018, looking at dietary fibre and risk of knee OA. Increased fibre intake leads to weight loss and other beneficial health effects but this trial suggests increased fibre intake also decreased the incidence of OA independent of reduction in BMI.
4. Precision study, looking at the issue of Celebrex and CV risk. This one they called a Big Splash and you will definitely be hearing more about this very large trial of 24,000 people followed for 11 years. Bottom line was a lower rate of major CV events and decrease in all-cause mortality, and lower GI and renal risks with Celebrex. The surprise was that Naproxen was not cardio-protective. Reassuring to tell our patients that Celebrex does not carry excess cardiac risk like Vioxx.
5. GiACTA is a "game changer." The largest RCT in GCA to date showed sustained remission and significant steroid-sparing with Actemra. This may change our practice very soon to save this patient population from steroid morbidity.
6. Nor-Switch is another trial you will hear much more about. It looked at non-medical switching of patients on Remicade to Inflectra in Norway. Dr. Kavanaugh felt there were design issues (e.g. different indications included in the trial, mostly IBD). The results showed that switching is not inferior to the innovator. These experts expressed concerns about biosimilars and pointed out that the savings in the US (15%) are much less than in Norway (70%).
7. Abstract #2049, infection in offspring of pregnant women with RA on biologic treatment. Reassuring that overall there were low rates of infections in the babies and not statistically different in biologic patients vs controls.
8. Abstract #418 was a quality control exercise by a fellow which became an ACR abstract. It looked at how frequently doctors discussed MMF risk in pregnant lupus patients and found alarmingly low rates of counselling on teratogenicity and even worse documentation of the discussion. There is definitely a need for improvement with education around this teratogen.
9. Cradle study of Cimzia levels in breast milk. This study found undetectable levels in 60% and extremely low amounts in 40%. Very encouraging data for our breastfeeding moms.
10. Finally, Abstract #87 was an ACR work force study. The number of rheumatologists in the US will be dropping by 40% in the not so distant future. This will be a gigantic challenge going forward. I don't know the exact numbers in Canada, but I suspect we will be in a similar boat.
These are some of the many, many learning points at this year's meeting. And that's a wrap from ACR 2016.
Dr. Shelley Dunne is a graduate of Memorial University of Newfoundland School of Medicine. She completed her training in Internal Medicine and a fellowship in Rheumatology at the University of Toronto. She has been in private practice since 1998 and is currently a consulting rheumatologist at the Toronto East General Hospital.View Full Bio