ACR Annual Meeting Highlights: Lupus Nephritis, COVID-19, Safe Pregnancies

November 6, 2020
Rheumatology Network Editorial Staff

This week marks the start of the 2020 annual meeting of the American College of Rheumatology. Some of the studies we're covering include new therapies for lupus nephritis. Belimumab was shown recently to improve renal outcomes in lupus nephritis patients when added to standard of care. It will likely emerge as a significant treatment option, says Dr. Fotios Koumpouras, fellowship program director for rheumatology at Yale School of Medicine and a Rheumatology Network board member. Dr. Koumpouras breaks down his highlights in this interview.

This week marks the start of the 2020 annual meeting of the American College of Rheumatology. It is a virtual meeting this year and could break attendance records.

Some of the studies we're covering include new therapies for lupus nephritis. Belimumab was shown recently to improve renal outcomes in lupus nephritis patients when added to standard of care. It will likely emerge as a significant treatment option, says Dr. Fotios Koumpouras, fellowship program director for rheumatology at Yale School of Medicine and a Rheumatology Network board member.

There will be more must-see presentations on lupus nephritis, including the best-in-class calcineurin inhibitor voclosporinwhich, with standard of carehas been shown to significatly improve renal outcomes in lupus nephritis.

We also plan to cover presentations on COVID-19 and its impact on patients with rheumatic disease.

In today's interview, Dr. Koumpouras reviews this and other studies you won't want to miss at this year's meeting.

INTERVIEW TRANSCRIPT

"Hello. I'm Dr. Fotios Koumpouras, I'm assistant professor of medicine at the Yale School of Medicine, program director for rheumatology, as well as director of the Yale lupus program.

I appreciate the few minutes that you are giving me here today. I would like to describe the upcoming scientific meeting for the annual meeting of the American College of Rheumatology, the ACR Convergence 2020. The meeting this year, as you might imagine, is completely virtual. This allows opportunities for many participants to be able to catch multiple presentations without all of the walking although, unfortunately, we will miss in person collegiality that typically occurs during these types of big meetings.

There is a lot of great interest going in rheumatology and I wanted to highlight some the great topics we will hear about during some of the ACR plenary sessions.

Lupus Nephritis

1. You're going to hear about new therapies for lupus nephritis, which made a splash at Kidney Week.

Belimumab, which is a therapy approved for lupus, was shown recently to improve renal outcomes in lupus nephritis when added to standard of care.

This will likely emerge as a significant treatment option for folks who have lupus nephritis.

What we'll see in that datum is that not only was it superior to standard of care in reducing proteinuria, but it also was important in reducing renal flares over the two-year period.

2. I'm interested in, and I think you'll hear about another treatment for lupus nephritis which is best-in-class calcineurin inhibitor called voclosporin, which was shown to significantly improve renal outcomes and features of lupus nephritis when added to standard of care therapy. And this could be an oral additional option for patients with lupus nephritis. The data looks very good and I know it's being evaluated at the FDA level.

COVID-19

3. We're going to see a lot data around COVID and how its impacted our rheumatology patients. One of the plenary sessions will be devoted to the outcomes of patients who have systemic autoimmune rheumatic DISEASES who have suffered from COVID. And, I think the data strongly suggests that there was actually an increase risk of organ damage in folks with systemic rheumatic diseases who did develop severe COVID.

Lupus

4. You're also going to hear about hydroxycholoroquine, a long-term therapy used in SLE. There's been increasing scrutiny over hydroxychloroquine's (Plaquenil) interference with the conduction system of the heart called the QTC. You're going to see hydroxychloroquine which is also used in rheumatoid arthritis good data to show the effect of hydroxychloroquine on the QTC interval in rheumatoid arthritis was minimal.

Vasculitis

5. I'm interested in attending a session on an optimal therapy hitting Complement C 5A (C5A) for the treatment of (ANCA)-associated vasculitis. This would offer a new novel therapy for folks who may be failing traditional therapy in an otherwise very serious disease.

Rheumatoid Arthritis

6. There's going to be a session that I would love to attend, but unfortunately there's a concurrent sessionbut this virtually I will be able to see in my own time. It's looking at when to stop therapy in rheumatoid arthritis. One of the plenary sessions will be devoted to discussing cessation of etanercept vs. methotrexate in otherwise stable rheumatoid arthritis. You will see the data suggests that folks who were maintained on etanercept monotherapy did better and maintained remission long term when therapy was de-escalated in rheumatoid arthritis.

Osteoporosis

7. You're going to hear about osteoporosis and better ways to treat glucocorticoid-induced osteoporosis. As you know, many of our patients require glucocorticoids for treatment of their diseases but that, in many, cause a thinning or decrease in density bone. And, we're going to learn how denosumab might be favorable at maintaining bone mineral density when individuals have developed glucocorticoid induced osteoporosis.

Pregnancy

8. I'm also interested in pregnancy in rheumatic diseases. And, one of the plenary sessions will be in reviewing those women who have interstitial lung disease who have become pregnant and had deliveries. We are going to see those folks who have had interstitial lung disease that maternal morbidity and mortality was actually low in pregnancy in those who have rheumatic disease and interstitial lung disease. So this is new data to suggest that perhaps this patient population may not suffer the morbidity that we initially thought. So that there's emerging data guidance of when pregnancies can be successful.

Community Hubs

9. The virtual ACR Convergence has set up something called Community Hubs. Even specialty HUBs, which is great. The participant can come and click on a particular hub that then will lead them to a series of programs related to that disease. The hubs are broken down by disease and are being managed by thought leaders in each of those segments. So it'll be a very easy way for paticupatns to actually come in and click around for disease specific knowledge.

Knowledge Bowl

10. There's going to be a knowledge bowl and as program director, I'm very interested in seeing the trainees interact. So the knowledge bowl is an opportunity for rheumatology trainees to compete in a Jeopardy style trivia question format. I'll be attending the Knowledge Bowl and something called the Thieves Market. This is a forum where people present unusual cases that have very high teaching value. I'm very much looking forward to attending that session.

There are numerous abstracts across all diseases so the abstract session, with it being all virtual, has allowed for easy search of specific topics for participants to easily access. I'm looking forward to the actual platform this year."

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