Friday, 19 Jul 2019

You are here

RheumNow Podcast – TNFs and the Inflammasome (1.25.19)

Dr Jack Cush reviews the news from the past week at RheumNow.com.

  1. Meta-analysis of 4719 elderly RA/IBD/PSO pts on biologics vs 13,305 younger vs 3961 older patients (no biologics) shows biologic use in elderly to be assoc w/ an increased risk of infections (3.6 fold increase in risk) but no increase in cancer or death https://t.co/pWtMMo2KQ1
  2. Using FMF-KI knockout mice (high TNF levels) researchers find TNF signaling drives pyrin & inflammasome activation; TNF is a critical modulator of pyrin of pyrin-inflammasomopathies like FMF. This is why TNF inhib sometimes work in inflammasomopathies. https://t.co/0EvuTI57tn
  3. Systematic review of literature and 478 RA patients (mostly female; age 53-64 yrs) shows 73 to 97% of patients being unaware of an increased risk of developing Cardiovascular Disease in relation to their RA, https://t.co/aNM3wI2KBo
  4. JAMA study shows that when drug companies increased their opioid marketing budgets by just $5.29 per 1,000 population, the number of MD opioid prescriptions went up 82% and opioid deaths increased 9%. https://t.co/4FAr53gH17 
  5. Using the 1998-2014 U.S. National Inpatient Sample- gout was associated with 9-20% higher healthcare utilization and 6% higher hazard of transfusion after primary hip replacement surgery. https://buff.ly/2U8wvwu
  6. Does Seropositivity Change with Therapy?
  7. Smoking Doesn't Influence Rituximab Responses in Rheumatoid Arthritis

 

Disclosures: 
The author has received compensation as an advisor or consultant on this subject

Add new comment

More Like This

Rituximab Safety Concerns when Used in anti-TNF Refractory RA

The SUNSTONE study evaluated the long‐term safety of rituximab in rheumatoid arthritis (RA) previously exposed to ≥1 anti–tumor necrosis factor inhibitors (TNFi) and showed a stable, but high, rate of serious infections, opportunistic infections and an overall higher mortality rate.

No Difference Among Biologics in Arthroplasty Infectious Risk

A large administrative claims analysis of rheumatoid arthritis (RA) patients undergoing arthroplasty has shown no difference among biologics with regard to the risk of infections, but corticosteroid use was associated with a dose dependent risk of infection. 

The Annals of Internal Medicine has published an analysis of peri- and postoperative infectious risk among RA patients receiving biologics or glucocorticoids.

Is Methotrexate Necessary with Tofacitinib?

Rheumatoid arthritis patients taking tofacitinib (Xeljanz) plus methotrexate who achieved low disease activity (LDA) may be able to withdraw from the latter agent without significant worsening of disease activity, a researcher reported at EULAR 2019 in Madrid.

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.