War on RA - Part 3: Useless Drugs

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We have options that are endless – we have 28 biologics in rheumatology; 19 approved for RA in the last 20 years, but 15 of these are me-too copies or biosimilars. We currently have 2 JAK inhibitors and may have 3 or 4 by year end. But what we really need is the right drug, at the right time, in the right patient – but how will we know.

Are Non-TNF Biologics Superior to TNF inhibitors?

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Current ACR and EULAR guidelines list TNF-inhibitors (TNFi) abatacept, rituximab, and tocilizumab as being equally effective after methotrexate or as second line therapies when treating rheumatoid arthritis.

EULAR Recommendations on Large Vessel Vasculitis

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Th European League Against Rheumatism (EULAR) recommendations for the management of large vessel vasculitis (LVV) was originally published in 2009. Since then there have been new randomised clinical trials and cohort analyses leading to an update the original recommendations.

Biologic Therapy Improves Psoriasis and Reduces CV Inflammation

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Psoriasis confers a significant risk of comorbidity, but is psoriasis associated with increased coronary inflammation and is this risk attenuated by biologic therapy?

JAMA Cardiology has published a cohort study of 134 consecutive patients with moderate to severe psoriasis, showing that biologic therapy was associated with a significant decrease in coronary inflammation as assessed by perivascular fat attenuation index, a marker of coronary inflammation associated with cardiovascular outcomes. Patients not receiving biologic therapy had no change in perivascular fat attenuation index at 1 year.

TNF Inhibitor and Biologic Induced Psoriasis

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Analysis of RA patients in the German biologics register, RABBIT, shows an increased risk of psoriasis with TNF inhibitor (TNFi) compared to csDMARDs and other non-TNFi biologics. 

RheumNow Podcast – FDA Hyperactivity (7.26.19)

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Dr. Jack Cush reviews the news, journal reports, and FDA releases and deliberations covered this past week on RheumNow.com

Tofacitinib Gets a New Boxed Warning for Blood Clots and Death with Higher Doses

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The U.S. Food and Drug Administration has approved new warnings about an increased risk of blood clots and of death with the 10 mg twice daily dose of tofacitinib (Xeljanz, Xeljanz XR), which is used in patients with ulcerative colitis. 

Efficacy of Maintaining or Switching to Baricitinib Monotherapy

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A post hoc analysis of baricitinib use in rheumatoid arthritis (RA) patients shows that while many patients respond well to baricitinib monotherapy or to switching to baricitinib monotherapy, those with less disease control respond well to the addition of methotrexate (MTX) to baricitinb.&nb

FINCH2: Filgotinib in Biologic Refractory Rheumatoid Arthritis

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The FINCH2 study has shown that filgotinib, an oral once daily JAK 1 inhibitor, is highly effective in rheumatoid arthritis (RA) patients who failed to respond to prior biologic therapy.

War on RA - Part 1: Walk on the Moon

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It’s a great time to be a rheumatologist and to manage RA. But, if you keep doing what you’re doing, you’re going to keep getting what you’ve got.

Upadacitinib Superior to Adalimumab in Methotrexate Refractory RA

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Upadacitinib, a JAK1-selective inhibitor, was studied head to head against adalimumab and placebo in rheumatoid arthritis after an inadequate response to methotrexate, and shown to be superior to ADA and PBO in ACR20 and DAS remission level responses.

Rituximab Safety Concerns when Used in anti-TNF Refractory RA

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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.

RheumNow Podcast – EULAR 2019 Streamin' - (6.14.19)

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Editor's note: July 1 - 5, RheumNow is running the best of the EULAR 2019 meeting. Dr. Jack Cush reports from Madrid on several novel presentations from EULAR 2019, including low-dose steroids in hand OA, ABA vs. ADA in double positive RA patients, psoriasis predictors of PsA, tildrakizumab and more.

No Difference Among Biologics in Arthroplasty Infectious Risk

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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. 

Is Methotrexate Necessary with Tofacitinib?

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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.

EULAR 2019- Day 4 Report

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Saturday June 15th was the last half-day at EULAR 2019 but was highlighted by the “late-breaking” (LB) presentations that were presented from the podium and by poster.

Below are the top “LB” presentations from EULAR this year:

RheumNow Podcast – EULAR 2019 Streamin' - (6.14.19)

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Dr. Jack Cush reports from Madrid on several novel presentations from EULAR 2019.

1. Genovese Vagal nerve stimulator in RA

Low Remission/LDA Rates with TNF inhibitors in Rheumatoid Arthritis

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Might IL-17 Inhibition Be Effective in RA?

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Interleukin 17 (IL-17) inhibitors are highly effective and FDA approved for use in psoriasis, psoriatic arthritis and ankylosing spondylitis. However, many of the initial trials were done in rheumatoid arthritis (RA) where it was projected to be effective, but was not. A recent metanalysis examines how effective IL-17 inhibition was in two RA populations: biologic-naïve or tumor necrosis factor inhibitor inadequate responders (TNF-IR).

RheumNow Podcast – Rituximab Monitoring (5.31.19)

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Dr. Jack Cush presents the news and best of rheumatology and medicine from the past week on RheumNow.com