Tuesday, 16 Jul 2019

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RheumNow Podcast – Rituximab Monitoring (5.31.19)

Dr. Jack Cush presents the news and best of rheumatology and medicine from the past week on RheumNow.com

Lupus Disease Control with Rituximab

Rituximab (Rituxan) may be an option for maintenance therapy in patients with difficult-to-treat systemic lupus erythematosus (SLE), European researchers reported.

The Cost of Physician Burnout

An article in the Annals of Internal Medicine has analyzed the cost-consequences of physician burnout, including costs related to physician turnover and reduced clinical hours.

2019 EULAR Guidelines on Antiphospholipid Syndrome Management

A EULAR task force has reviewed the medical literature and developed evidence-based recommendations for the management of antiphospholipid syndrome (APS) in adults. They note that a high-risk antiphospholipid antibody (aPL) profile is associated with greater risk for thrombotic and obstetric APS.

Biologic Retention in Ankylosing Spondylitis Patients

A study of biologic-naïve patients with ankylosing spondylitis (AS) who started therapy with a tumour necrosis factor inhibitor (TNFi) shows that after 5 years only 46% are still on a TNFi and that some are able to lower the dose over time.

A nationwide Swedish Rheumatology register followed 2590 Bio-naïve AS who started a TNFi between 2006–2015.

Upadacitinib Monotherapy in MTX-IR Rheumatoid Arthritis

Upadacitinib (UPA) is an oral, selective JAK1-selective inhibitor being developed for use in rheumatoid arthritis patients; Lancet has reported the SELECT-MONOTHERAPY trial showing that UPA is safe and effective in RA patients with an inadequate response to methotrexate (MTX).

This multicenter study randomized 648 patients, of whom 598 (92%) completed week 14.  

At week 14, an ACR20 responses were:

Predictors of Serious Infections with Rituximab

The risk of serious infectious events (SIE) with rituximab (RTX) is similar to that seen in other biologics (e.g., RA: 2% or 4.3/100PY), but with prolonged use the risk may change. Recent research says that low IgG levels, RTX induced neutropenia, prior SIE and comorbidities can significantly augment this risk. A retrospective longitudinal single center study of 700 rheumatic and musculoskeletal diseases (RMDs) treated monitored serum immunoglobulins (at baseline and 4–6 months after each cycle), clinical outcomes and SIE over time.

RheumNow Podcast – Medical Selfies (5.24.19)

Dr. Jack Cush Reviews the news and journal articles from the past week on RheumNow.com

Additive Effects of Insomnia and Depression on Osteoarthritis

A study of osteoarthritis patients, finds that pain is the primary driver for health care utilization, and that the presence of insomnia or depression augments health care use.

 A total of 2976 OA patients were followed for 3 years and assessed for pain (Graded Chronic Pain Scale), insomnia (Insomnia Severity Index), and depression (Patient Health Questionnaire‐8), and health care use (from electronic health records).

ACR Statement on CMS Medicare Advantage Final Rule

 In August 2018, the CMS announced that Medicare Advantage (MA) plans would be allowed to utilize step therapy for Part B drugs. The American College of Rheumatology (ACR) expressed strong concerns about this proposal. The rheumatology community received some good news in this week’s final rule from CMS, which makes changes to the original proposal and addresses several of the community’s recommendations.

Lung Disease in RA: Which Factors are Linked With Mortality?

Among patients with rheumatoid arthritis (RA) who had interstitial lung disease (ILD), the pattern of ILD did influence mortality, but other pulmonary factors also contributed, a meta-analysis suggested.

Lupus Outcomes Influenced by Race/Ethnicity

A lupus registry from San Francisco County analyzed racial/ethnic differences in lupus manifestations and found significant differences in SLE manifestations among racial/ethnic groups. Researchers found that Blacks, Asians/Pacific Islanders (API), and Hispanics are more likely to develop severe manifestations following a diagnosis of SLE. From their database, they identified 724 SLE patients, and identified specific features in different subgroups.