Friday, 19 Jul 2019

News

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.

Nintedanib May Benefit Systemic Sclerosis Related Interstitial Lung Disease

The NEJM reports a randomized placebo controlled trial of nintedanib, a tyrosine kinase inhibitor, in systemic sclerosis patients with interstitial lung disease (ILD) resulted in less pulmonary decline, but had no effect on other features of systemic sclerosis. 

Steroids, Not Biologics, Drive Arthroplasty Infections in RA

Medicare and Truven MarketScan administrative data study (2006 through 2015) of rheumatoid arthritis (RA) undergoing arthroplasty found that while that the risks of perioperative infection was similar across biologics, the infection risk with glucocorticoid use, especially at > 10 mg/d, was significantly greater.

EMA Restricts Tofacitinib Dosing

The Pharmacovigilance Risk Assessment Committee of the European Medicines Agency issued recommendations limiting the use of Xeljanz (tofacitinib) 10 mg twice daily in patients with ulcerative colitis in the EU. The new recommendations are temporary while PRAC undertakes a review of all available evidence on the safety and efficacy of tofacitinib. The review follows warnings of an increased risk of pulmonary embolism (PE) and death from the U.S. Food and Drug Administration based on Pfizer's large post-marketing safety study (in high risk rheumatoid arthritis patients with one or more underlying cardiovascular risk factors) wherein those receiving in tofacitinib 10 mg twice daily in study A3921133 had more PE and mortalities than comparator groups (tofacitinib 5 mg bid or adalimumab).

Opioids, SSRIs and Steroids Increase Fracture Risk in RA

Analysis of a large US observational rheumatoid arthritis (RA) patients finds that opioids, SSRIs and glucocorticoids were associated with increased risk of fracture in RA, whereas statins and TNFi had a decreased vertebral fracture risk.

RheumNow Podcast – Richer or Poorer (5.17.19)

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