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Dr. Jack Cush reviews highlight abstracts and sessions - covering lupus, RA, gout, Still's disease, safety data, AI in medicine and more - from last week's EULAR 2023 Congress held in Milan, Italy.
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A nationwide population-based study, by Beydon et al. (OP0044), has performed a more recent (2010-2020) analysis of cancer incidence in people living with RA within the French national claim database, compared to general population, measured in the French Network of Population-Based Cancer Registries.
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Dr. Jack Cush reviews the news and journal reports from this past week on RheumNow.com. This week we delve into some odd associations, repeat drug warnings and the consequences of antirheumatic therapies.
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Peresolimab is a humanized IgG1 monoclonal antibody that acts as a programmed cell death protein 1 (PD-1) agonist (stimulator). The NEJM reports that PER met its efficacy primary endpont in treating patients with active rheumatoid arthritis (RA).
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Genetic blood tests indicated that Bruton's tyrosine kinase (BTK) and a cytokine called APRIL were overexpressed in patients with primary Sjögren's syndrome who subsequently developed lymphoma, French researchers reported, suggesting that BTK inhibitors might be useful in this population.
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Dr. Jack Cush reviews the news and journal reports and addresses 3 viewer case questions.
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Lancet Rheumatology has published a retrospective analysis showing patients receiving immune checkpoint inhibitors (ICI) for cancer have the same outcomes (mortality and severe immune-related adverse events (irAEs)) even when they have pre-existing rheumatoid arthritis (RA).
Dr. John Cush
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JAKi in Rheumatoid Arthritis: Cancer and Cardiovascular Risks
Dr. Antoni Chan discusses abstracts OP0132, POS0831, and OP0133 presented at EULAR 2023 in Milan, Italy.
https://t.co/ApLaPf7uKP https://t.co/nbZgwIlHyb
Dr. John Cush
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RA and cancer risk in the biologic era
RA is known to be historically associated with site specific cancers, especially lung skin and lymphomas. This risk was described as likely to be supported by chronic systemic inflammation before the biologic era.
https://t.co/4Pe6SIS6yb https://t.co/e2enjkXoly
Md Yuzaiful Md Yusof
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#EULAR2023 #POS1069 SLR & meta-analysis to inform EULAR Points to Consider which included 15 studies showed that targeted therapies were not associated with increased risk of cancer recurrence in patients with inflammatory arthritis AND a historyof cancer (85% had RA) @RheumNow https://t.co/uK2XHLjpj8
David Liew
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For our rheum patients who have had cancer previously - the default can’t be to not have DMARDs.
@eular_org points to consider SLR:
no clear risk, across b/tsDMARDs
For too long these patients were unnecessarily asked to ride it out. No more please
POS1069 #EULAR2023 @RheumNow https://t.co/7m4Yh0h7rd
Janet Pope
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#JAKi May decrease #cancers - age, male, #diabetes had more #cancer but NOT associated w drug prescribed AND LESS #malignancy & LESS #CVE in JAKi vs csDMARDs in huge admin database. Diff from other results OP0140 @RheumNow #EULAR2023 EFFECTIVE Rx of RA LOWERS CVE & cancer w JAKi! https://t.co/oQ3QeUZz3E
Dr. John Cush
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Metanalysis of 62 RCTs, 16 LTEs, 82 366 Pt-Yrs JAK exposure. JAKi malignancy incid rate = 1.15/100 PYs in RCTs (1.26/100PYs overall). Network meta-analyses show no diff betw JAK & PBO or MTX in NMSC, but signif increased malignancy risk (IRR 1.50) https://t.co/kk12pa17Nn https://t.co/qEcRatKRSf
Aurelie Najm
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Beydon et al., french registry study 255000+ RA patients 2010-2020
Increase ⬆️ overall malignancy by 20% vs. general pop
⬆️lung 40%, ENT 40%, cervix 80%, prostate 8%, melanoma 37%
Pancreatic cancer 10% less frequent in ♂
Breast 9% & Uterine body 23% less frequent in ♀
Aurelie Najm
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EULAR PtoC management of targeted therapies in pts w/ IA & Hx cancer
1) If remission, initiate targeted therapy w/out delay
2) Prefer anti-cytokine bDMARDs if Hx solid cancer
3) B cell depleting therapy if Hx lymphoma
4) Use JAK inhibitors and abatacept with caution 🛑 https://t.co/cKhQVZwGh1
Dr. John Cush
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Dr. Anisha Dua on Imaging in PMR:
- US of shoulders to eval for bursitis can increase specificity
- MRI better for pelvic girdle, but expensive
- Consider PET if lack of response to steroids, r/o malignancy
#RNL2023 @RheumNow https://t.co/tjhGlJPDWZ https://t.co/9h1FwfM0CP
Dr. John Cush
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Matched cohort study of 67,598 German primary care Pts shows gout have incr risk of breast cancer (4.5% gout vs 3.7% non-gout; HR: 1.17; 1.05-1.31). Association only seen under age 50 (HR: 1.58; 1.10-2.27), but notin women over 50 yrs https://t.co/pl6gH2GyZQ https://t.co/VR8kuumhNv
Dr. John Cush
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Review of the etiology of Polyserositis (14 pts, 23 articles): most common - neoplasia (26.3%; Lung Lymphoma; ovarian; pancreatic), autoimmune (16.7% - SLE, AOSD) & infections (12.3%; coxackie, CMV, mTB). https://t.co/Bubd99ETgu https://t.co/VbiPB0y7pv
Dr. John Cush
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A Danish national registry study compared RA pts taking JAKi (n 875) and bDMARDs (n 4247). They found similar rates of subsequent cancers (14.4 vs 12.9/ per 1000 PYRS); with a nonsignificant risk (HR1.41; CI 0.76, 2.37) https://t.co/wfrlAcij8x https://t.co/OvqKrHw5Wu
Dr. John Cush
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Immune Checkpoint Inhibitor Safety with Pre-existing Rheumatoid Arthritis
Lancet Rheumatology has published a retrospective analysis showing patients receiving ICI for cancer have the same outcomes even when they have pre-existing RA.
https://t.co/aFNZX5YaLD https://t.co/ZY9Ie8TOPc
