Shane Shapera

Excited to start the first clinic with @yassmin_behzadian our new ⁦⁩ILD Fellow this year. We are both in our September #PF awareness T-shirts courtesy of the Canadian Pulmonary Fibrosis Foundation⁦. Her ILD fellowship made possible thanks to funding from ⁦@THE_CPFF⁩

Exciting news for patients living with progressive pulmonary fibrosis (#PPF). It looks like #nerandomilast is going to change the treatment landscape for both #IPF AND #PPF. 🥳 I can’t wait to see more details when the papers are published.

@EBRheum @NEJM @RheumNow @EBRheum, where do you stand on Rx of MDA5? Is TOFA your top choice? If not, where does it fit into the hierarchy of treatment options for non-pulmonary disease? Would you ever use TOFA for MDA5 with RP-ILD?

Interesting comparative effectivness study, TOFA vs calcineurin inhibitors in MDA5-dermato Expansion of prior publication @NEJM that used historical controls: nejm.org/doi/full/10.10… Encouraging data for JAKs in this disease; need proper trials #ACR24 @RheumNow Abstr#1736

@jolenehfisher, @twhcmr and I were honored to have @drdayjee at our @UofTRespirology #ILD educational day. He gave a fantastic talk on genetics of ILD and biomarkers: past, present and future. Thanks @drdayjee for coming along the way to Toronto to enhance our event! 🙏🙏🙏

@SindhuJohnson5 @UofTRespirology @jolenehfisher We were so happy to have you at our event. Your talk was excellent and you provided so many important insights and pearls for the group. We are all so impressed with your amazing leadership on the SARD-ILD guidelines. I feel fortunate to have you as a friend and colleague.

Congratulations @UofTRespirology @shapps999 on a fantastic educational day on #ILD. 🫁⚕️🩻 📊 I am thrilled to be speaking alongside @jolenehfisher @leefider #DrMeyerBalter. So much to learn from interdisciplinary discussions. 🧐🤔🙂

They showed that 35% of patients with AE-ILD are frail. These patients had more major complications (32% vs. 10%, p=0.01) and required more multi-disciplinary support during hospitalization. Identifying these patients early can help target allied health interventions early.

Congratulations to Dmitry Rozenberg and his team for their recent publication on the impact of frailty on outcomes after acute exacerbation of ILD. pubmed.ncbi.nlm.nih.gov/38515270/ This work is supported by @THE_CPFF.

@twhcmr @respandsleepjc Agreed. There are many things we do in ILD clinic because we suspect it is helpful without evidence of efficacy and safety. We have been burned before, so it is good to see a well conducted study show that morphine is safe and can improve symptoms (important outcome for patients)

@respandsleepjc Great discussion regarding PACIFY-cough at resp journal club. Compelling results of a meaningful outcome in IPF. Great to see patient reported outcomes being the focus!

@respandsleepjc This was a very disappointing result. Unfortunately, it is one of several recent negative phase 3 studies in the last couple of years. It has been 10 years since we had a new treatment in IPF. Despite current therapies. It remains the most common reason for transplant. 😢

#rsjc critical appraisal by Dr Martyn Can the results be applied to my patients?

Naomi Matsushita of Toronto, Ontario, Canada, has interstitial pneumonia, one of the 200 types of pulmonary fibrosis (PF), as well as anti-synthetase syndrome, an auto-immune condition. #HopeBreathesHere This is her story. bit.ly/3Yqn903

Excitement about cell based therapy in SSc. Towards a cure academic.oup.com/rheumatology/a… Also, a recent podcast on cell based Rx emjreviews.com/rheumatology/p… @scleroderma @UMIntMed

@KerriBerriKerri @jolenehfisher @twhcmr @LeighMinuk @veronicasam940 @gilliangoobie @veronicasam940 @thelungdr @drstanbrook

@KerriBerriKerri @respandsleepjc So, the question is: Is RECITAL enough to solidify Rituximab in the ranks of mycophenolate and tocilizumab in the arsenal of immunosuppressive therapy you would use in #CTD-ILD?

@KerriBerriKerri @respandsleepjc Agreed. Plus, with the challenges we saw with recruitment in #RECITAL and with Rituximab off patent, a phase 3 is not in the cards.

#rsjc Live Discussion Is there enough here to do a bigger trial of Rituximab versus Cyclophosphamide? This likely reinforces what people do already. It is exciting in ILD when we can slow decline . In both cases there were improvement. This study reinforces the fact that

@KerriBerriKerri @respandsleepjc @KerriBerriKerri - We usually give 2 doses every 6 months for 1-2 years. Then if things going well we extend duration between cycles. Some patients can be weaned off to MMF alone. Others flare every time dose is delayed for years. How long do you continue Ritux? What’s ur exp?

#rsjc Critical Appraisal Was follow up complete? Yes up to 24 weeks. After that, slightly variable. Only 69% of patients in the rituximab completed full follow up to 84 weeks and around 80% in the cyclophosphamide group.

@respandsleepjc @LancetRespirMed Hats off to @TobyMMaher and the rest of the study team for this important step forward in #ILD care.

@respandsleepjc @LancetRespirMed Another #CTD-ILD study with a negative primary endpoint. Sound familiar? (#SLS-1).

Join us tomorrow for our last #rsjc of 2022! Must tweet attendance for @Royal_College S1MOC credits! Starts at 7pm

@respandsleepjc @LancetRespirMed The similarities with Mycophenolate and SLS-2 is remarkable. …and mycophenolate has become our go-to first line drug.

@respandsleepjc @LancetRespirMed We have been doing this for years but it is great to have some data to support this practice.

@respandsleepjc @LancetRespirMed The fact that both groups improved is highly suggestive that Rituximab has a role in CTD-ILD.

@respandsleepjc @LancetRespirMed However, from multiple studies we know the natural history of CTD-ILD is to worsen over time. We saw this in SLS-1, SENSCIS and many other studies and retrospectives. This is especially true for patients where risk is high enough that clinician is willing to use cyclophosphamide