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The RheumNow Week in Review – 6 January 2017

Dr. Jack Cush reviews highlights from the first week of 2017 on

Happy New Year!

  1. RheumNow celebrates its 4000th Anniversary Tweet! It all started with the goal to share a pearl, study result, or the answer to test question. Wisdom prevails!
  2. Among 40,000 Dutch, 1% had ACPA+; 22% had RA. ACPA associated with being older, female, joint symptoms, smoking, RA, relatives of RA.
  3. Big decline in 2016 new drug approvals; 22/2016, (45/2015, 41/2014); 9 were for orphan drugs; 8 were firs in class, the number of new filings is unchanged. (No new drugs for arthritis or Rheumatology. These do not include 3 new TNF biosimilars)
  4. TNF inhibitor survival in 2687 Finnish patients - 27% discontinue TNFi in 12 mos. Worse with CZP & Remicade, better with combo MTX
  5. Decline in chemokine CXCL4 in MMF Treated patients with improved ILD & scleroderma - epiphenomenal or pathogenic?
  6. NICE recommends apremilast for use in psoriatic arthritis within UK NHS. Risk of suidical ideation is only 0.2% (3/1441).
  7. NY Times article says Acthar is "single most expensive drug per patient" costing Medicare $16,2371 per patientst for 3100 Medicare patients treated with Acthar.
  8. CDC Grand Rounds on Chronic Fatigue Syndrome (AKA Myalgic Encephalomyelitis) (ME/CFS) fails to recognize Fibromyalgia as same disease.
  9. Systematic review of >1000 IBD pts treated with biosimilar CT-P13 vs Remicade shows no difference in efficacy, safety, ADAbs
  10. CDC confirms current influenza vaccines correctly cover strains seen thus far in 2016 and for 2017. Also these strains are senstive to available antiviral Rx (eg, Tamiflu).
  11. Hospira (biosimilar division of Pfizer) began to ship its Inflectra biosimilar to U.S. wholesalers on Nov. 21 & has a sales force in place
  12. Iron deficiency anemia associated with a 2 fold increased risk of sensorineural hearing loss. IDA & SNHL is found in 1.6% of the population.
  13. Myriad faces loss of Medicare pay for RA VECTRA-DA test, based on recent CMS report. The test is still available.
  14. Incident RA prevalence = 0.63%; 2/3 are treated with a DMARD; but 28% were not. How many have never seen a rheumatologist? 38% @1yr & 15% @2yr never seen by Rheumatologist
  15. Weight loss improves Psoriasis. 
  16. Pregnancy Outcomes in Psoriatic Arthritis.
  17. Biopsy Proven Renal Involvement in Sjogren's Syndrome
  18. Modest Benefits with Intraarticular Corticosteroids in Knee Osteoarthritis 
  19. PPI Safety Issues 
  20. A Low Risk of Inflammatory Bowel Disease with IL-17 Inhibition
  21. CHMP Recommend Baricitinib for Approval in Europe 
  22. A Link Between Periodontal Disease and Rheumatoid Arthritis
The author has received research/grant financial support on this subject
The author has received compensation as an advisor or consultant on this subject

Rheumatologists' Comments

In regards to the Finnish study on TNF inhibitor survival, I suspect the results would be even more in the USA as many"sero-negative" RA patients who are presumed to have RA or "inflammatory arthritis" (not to mention the ever-growing number of nr-axSpA patients) receive a trial of empiric therapy with biologic biologic agents that don't pan out. As the saying goes, "you see what you know" and there is a lot we still don't know about this group of" RA-look alikes".

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