Plenary sessions began the day, followed by thousands on the abstract floor. Here are a few of my favorite presentations from day 2 at ACR 2024.

Statins and major adverse cardiovascular outcomes

• Abstract 1745 was presented by Dr John Giles and was a re-analysis of the Oral Surveillance data. The study showed suboptimal statin use in this study and how that might have affected the cardiovascular event rates that became part of the JAK inhibitor (JAKi) warnings. High cardiovascular risk RA patients were enrolled-over age 50 and treated with either a JAKi or a TNFi inhibitor. Only 23% of the population was on a statin at enrollement. Also, of those with a high predicted risk for atherosclerotic cardiovascular disease only 27% were taking a statin. Moreover, patients on statins were unlikely to be taking high intensity statin doses. The number of new statin starts were more frequent in the JAKi group compared to the TNFi group. If patients were on a statin, the effect of the JAKi on LDL was much less; hence the benefit of being on a statin. Baseline statin use was associated with less LDL increases. Overall, MACE events were equal between TNFi and JAK inhibitors, when the patients were treated with a statin.

The risk of malignancy with JAK inhibitors.

• Abstract 1336. This poster presented today was based on a large claims analysis from Japan that involved over 50,000 RA patients. They compared the number of malignancies seen in patients treated with methotrexate, JAKi, TNFi inhibitors, and non TNFi drugs. There cohorts were large with 4395 on JAKi, 20798 on biologic DMARDs, and 37,000 on methotrexate (80% were on MTX). The overall malignancy incidence rates were generally higher for patients taking methotrexate – not surprising as undertreated, uncontrolled and inflamed patients are generally at higher risk of cancer. The main finding of this study was that increase rates of malignancies were seen in patients on JAKi – maily lung cancer and lymphoma, the two most common cancers seen in patients with active rheumatoid arthritis. While these data support the findings of the Oral Surveillance study, there have been many other studies published lately that contest this issue, showing either no increase in cancers in RA patients, or no difference between commonly used treatments. This study differs by looking a a large cohort of generally severe RA patients (requiring hospitalization). Nonetheless, some may look at this as evidence for a cancer risk with JAKi. I look at this as saying that TNFi is better than JAKi in curtailing inflammation and cancer risk in active, severe RA patients.

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