RheumNow Podcast – Prevalence of Methotrexate Toxicities (6.28.19)

Jack Cush, MD

Jun 28, 2019 9:47 am

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

Metanalysis of 3954 studies, 20 RCTs examined MTX toxicity and found the prevalence of alopecia to be 1- 4.9% and the prevalence of stomatitis to be between 5.7-8% https://onlinelibrary.wiley.com/doi/abs/10.1002/acr.23999
A Western Norway study of GCA (1972–2012) compared 792 GCA (528 Bx-verified) to 2577 matched controls. There were no differences in overall survival (p=0.41). GCA had higher risk of CV death (HR 1.31) but lower risk of cancer deaths (HR 0.56). https://t.co/oBx2kBTyrZ
795 RA patients from the GIRRCS cohort 3 year study found that maintaining remission reduced the incidence of subclinical atherosclerosis by three-quarters (OR = 0.25; P = .001). (87% were on MTX; 60% on biologics) #EULAR2019 ABST# OP0090 https://t.co/RvRcXsDnKs
Study of 1224 SLE pts found 7% with neuropathies (PNS) w/ 2/3 attributable to SLE. 67% PNS occurred w/in 3 mos of SLE diagnosis. Periph. polyneuropathy was most common (43%). PNS pts were older, w/ higher SLEDAI-2K, Sjogrens, livedo, HTN, DM. https://t.co/G7l2GGbmgR
2,899 RA and 112,571 OA pts had THA or TKA. RA had more infections (HR 1.29;1.03-1.61) post THA/TKA, but fewer VTE (HR 0.60; 0.26-0.98) post TKA. Biologics in RA had a similar infx risk but more VTE (HR 4.82;1.67-13.9) vs non-biologics. https://www.sciencedirect.com/science/article/abs/pii/S0049017219302811?dgcid=rss_sd_all
Study of PsA (N = 341) pts starting secukinumab with or without a baseline loading dose of SEC 150 mg, showed equal ACR20 responses at week 16 - 41.2% vs 39.8%. Despite some w/ an earlier response, the SEC loading dose may not be necessary. https://www.ncbi.nlm.nih.gov/pubmed/31228101
CDC reports a 3-10mos shortage of Aplisol, a PPD product. Another PPD product, Tubersol is available for skin testing. CDC recs to use IGRA blood tests for TST & prioritize TSTs. Switching from PPD to IGRA may result in conversions requiring interpretation https://t.co/eJGOHVCbkO
"Clinicians should assess test results based on the person's likelihood of infection and risk for progression to TB disease, if infected," according to the CDC. MMWR. 2019;68:552-553. https://www.cdc.gov/mmwr/volumes/68/wr/mm6824a4.htm
DMARD Success in Myositis-Related Interstitial Lung Disease
Steroids in GCA and PMR Increase Infectious Risk
Mortality from Falls in the Elderly