THE OFFICIAL NEWS SOURCE OF ACR CONVERGENCE 2022 • NOVEMBER 10-14



MTX drug holiday increases flu vaccine effectiveness in RA patients

Discontinuing methotrexate (MTX) for two weeks after vaccination improves the immunogenicity of a seasonal influenza vaccine in patients with rheumatoid arthritis (RA) on a stable dose of MTX without meaningfully increasing disease activity, reported a researcher from South Korea during Sunday morning’s Plenary Session I.

Jin Kyun Park, MD, said the post-vaccination seroprotection rate was higher for all four antigens included in the vaccination in the MTX-hold group than in the MTX-continue group. Additionally, researchers showed a greater than four-fold increase of hemagglutination inhibition antibody titer at four weeks after vaccination against two of four vaccine strains in the MTX-hold group compared with MTX-continue.

“There was a minimal worsening DAS28. The flare rate was 5 percent in the MTX-continue group and 10 percent in MTX-hold group, but there was no statistical difference,” said Dr. Park, Assistant Professor of Medicine at Seoul National University Hospital.

Another study also looked at the impact of a drug holiday, this time looking at the benefits and risks of stopping bisphosphonates (BP).

“The benefits and risks of stopping bisphosphanates and the optimal timing to restart given this dearth of evidence remain quite unclear. Some might contend this is really the major question we grapple with as clinicians and bone experts,” said Jeffrey R. Curtis, MD, William J. Koopman Endowed Professor in Rheumatology and Immunology at the University of Alabama-Birmingham.

He presented results from a large cohort study of U.S. women showing that a BP drug holiday longer than two years was associated with a significantly increased risk for hip fracture of up to 39 percent compared with continued BP use.

The study identified 156,236 women who were highly adherent, long-term BP users, the majority of whom used alendronate. At median follow up of 2.1 years, about 40 percent of the women stopped BP therapy for at least six months or more. Among these, almost 13 percent subsequently restarted any BP.

“While we did find some increased risk, particularly for hip fractures, we do know that the absolute fracture rate differences between the continuers versus those who stopped was relatively modest. Clearly, there is still a lot of work that we need to know to determine when we might optimally restart individual patients,” Dr. Curtis said.

Results from another study demonstrated that chronic activation of TGF-β signaling perturbs the epigenetic control of STAT signaling by DNMT3A-induced silencing of SOCS3 expression in systemic sclerosis. Clara Dees, PhD, Researcher in the Department of Medicine 3, Rheumatology and Immunology, at the University of Erlangen in Nuremberg, Germany, said that re-establishment of the endogenous regulation of STAT signaling, either by forced expression of SOCS3 or by pharmacologic inhibition of DNMTs, prevents aberrant STAT3 signaling, inhibits TGFβ-induced fibroblast activation and collagen release, and ameliorates experimental fibrosis.

Titilola Falasinnu, PhD, an epidemiologist at Stanford University, reported results from a study that suggest race may transcend social and geographical parameters as a key determinant of mortality in patients with systemic lupus erythematosus (SLE).

Using death certificate data and Murray’s “Eight Americas” race-county combinations framework, researchers found that blacks sharing the same social and geographical contexts as whites were disproportionately more likely to die young and exhibit severe patterns of mortality. Additionally, although blacks inhabited three vastly different geographical and social contexts, SLE mortality parameters did not vary among socially advantaged and disadvantaged blacks.

The last presentation reviewed performance on quality measures in the RISE Registry and the Merit-Based Incentive Payment System (MIPS).

Jinoos Yazdany MPH, MD, noted significant variation in performance on quality measures in the first three quarters of 2017 across Rheumatology Informatics System for Effectiveness (RISE) registry practices, with some practices having already achieved a very high level of performance. Dr. Yazdany, associate professor of medicine at the University of California, San Francisco, described the RISE informatics platform and its functionality to assist rheumatologists in meeting MIPS performance reporting requirements.

“There are 15 rheumatologists who already completed all three domains on the RISE MIPS dashboard, and I’m very happy to report that all of them have crossed the high performance threshold. This is great news, and it suggests that people are going to do very well in this program,” she said.