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RheumNow Week in Review - Do you Dig Shingrix? (4.6.2018)

Dr. Jack Cush reviews the news and journal reports from the past week on RheumNow.com. Highlights includes manpower shortfalls, comorbidities in AA Lupus, certolizumab pregnancy safety, which Shingles vaccine is best and the power of combination biologics in severe refractory  SLE.

  1. In a historical prospective cohort study, PPI use in RA (1:4) was associated with a doubling of risk for acute kidney injury (HZ 2.30: 1.26-4.20) but was only 2.2 AKI per 1000PY in RA/PPI+ vs 0.9/1000PY in RA without PPI. Thus depends on need for PPI https://t.co/TxqjAR7Y5Y
  2. In early arthritis clinics in Leeds and UK ERAS study (454 &895 pts), DMARD free remission seen in 15-9.4%; predictors included acute onset, short Sx duration, NO smoking, No Xray damage, Seronegativity, absent HLA shared epitope alleles https://t.co/3yulHyrS4O
  3. Shingrix captured 90% of shingles vaccine market, w/ greater efficacy & CDC endorsement, plus is NOT a live vaccine & could be used with biologics. While cost is the same, it has more nuisance side effect & no studies/data in RA, CTD. https://t.co/lycVu8JrQq
  4. Shingrix is an inactive, subunit vaccine for H. zoster, >50 yrs, given as 2 IM doses (0.5 mL each), 2nd dose 2-6 mos after 1st. Shingrix is more effective than Zostavax but has more side effects. Unlike Zostavax, Shingrix can be given to biologic pts. https://t.co/k4eUW9mbdO
  5. In Ireland, waiting time/list to see a pediatric rheumatologist has grown 33% from previous year, with 902 waiting — 543 were waiting more than 12 mos (was 302 Jan 2017). Stems from a delay in implementing a new model of care for paediatric rheumatology. https://t.co/0V2Xu9gRrC
  6. 2015 US Pharma donated $116 million to Pt advocacy groups. For example Patients for Biologics Safety & Access (who opposes biosimilar substitution and includes Crohn’s & Colitis, Arthritis & Lupus Foundations) accepted $9.1 million from drug companies https://t.co/i3WDjNHu6f
  7. Increased Comorbidity Burden in Lupus African Americans   
  8. SynBioSe: Combo Rituximab and Belimumab Succeeds in Severe Refractory Lupus 
  9. ACR Projects Significant Manpower Shortages for 2030    
  10. Favorable Certolizumab Safety Profile in Pregnancy  

 

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

Rheumatologists' Comments

Do we know if Shingrix, with it's potent adjuvant, may cause RA to flare?

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