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Serious Adverse Events Associated with Tocilizumab in COVID-19 Patients

Jack Cush, MD

Safety analysis of over 1000 adverse events associated with the use of tocilizumab in the treatment of COVID‐19 infection shows both rare expected and some unexpected AE.

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When to Stop Biologics in Systemic JIA?

Jack Cush, MD

Systemic onset juvenile idiopathic arthritis (sJIA) is a dramatic onset inflammatory condition marked by spiking fevers, intermittent rash, polyarthritis and a host of other hyperinflammatory manifestations.

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Cytokine Inhibitor Lung Disease in Still's Linked to HLA-DRB1 Alleles

Jack Cush, MD

Pulmonary complications in the setting of Still's disease (juvenile and adult) has seldom but consistently been reported, including reports of pneumonitis, pulmonary hypertension and a severe or fatal lung disease, often associated with hypersensitivity to anticytokine therapy. A multicenter study reports that drug hypersensitivity and pulmonary reactions in Still's patients receiving IL-1 or IL-6 inhibitors is strongly associated with HLA-DRB1*15 haplotypes.

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The Influence of Obesity on Choice of Biologic in Rheumatoid Arthritis

Richard Conway, MBBChBAO, PhD

In rheumatoid arthritis we have a wide range of options available to us when we progress to a biologic treatment option. We have little to differentiate between these agents based on the clinical trials.

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Top vasculitis takeaways from ACR 2021

Janet Pope, MD, MPH, FRCPC

There were several hot topics at ACR21. Here I concentrate on top abstracts in vasculitis. 

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The Influence of Obesity on Choice of Biologic Agent in Rheumatoid Arthritis

Richard Conway, MBBChBAO, PhD

In rheumatoid arthritis we have a wide range of options available to us when we progress to a biologic treatment option. We have little to differentiate between these agents based on the clinical trials.

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FDA Update: 3 trials showing Efficacy of Tocilizumab in COVID 19: 1. RECOVERY - lower mortality 2. EMPACTA - Less progression to mech vent or death 3. REMDACTA & COVACTA - did not meet primary endpoints (but not contradictory) FDA Metanalysis of all 4 trials #ACR21 EUA 6/21 https://t.co/9yHu87KGej
Dr. John Cush RheumNow ( View Tweet)
TCZ in GCA: one disadvantage is that you can't use CRP+/- ESR for flares Mavrilimumab in GCA: - CRP/ESR consistently go up with symptomatic flares - CRP/ESR up less (cf. placebo), in the absence of Sx flares More signal, less noise. phase 2 post-hoc #ACR21 ABST1401 @RheumNow https://t.co/c0lMJMcQv0
David Liew drdavidliew ( View Tweet)
NORD-STAR Trial: outcomes in tx-naïve, early RA pts after 48w of csDMARDs+GC vs bDMARD (ABAtacept, CerToliZumab, or ToCiluZumab)+MTX ➡️ Superior CDAI remission rates w/ ABA+MTX & CZP+MTX but not TCZ+MTX vs csDMARD+GC ➡️Imaging progression low in all Abst#0825 #ACR21 @RheumNow https://t.co/QaFIF4WNEG
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
#ACR21 Abs#0834: CorEvitas Registry TNFi vs IL-6 in RA ⭐️IL6 pts older, longer h/o RA, higher CDAI, more prior Rx ▶️ No difference in outcomes bw IL6 and TNFi (monotherapy or combo w MTX). ▶️1/3 of pts achieved LDA Limits: real-world, unblinded https://t.co/AJtzeMuj1T @Rheumnow

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Eric Dein ericdeinmd ( View Tweet)

ADACTA & MONARCH both showed IL6i monoRx > TNFi monoRx for RA in DBRCTs. What about in real-world data? Looking at CorEvitas, less so LDA: aOR 0.99 MCID in CDAI: 1.06 Even without MTX, both great drug classes for RA Equally so? #ACR21 ABST0834 @RheumNow https://t.co/6wvzVrXTW6 https://t.co/fYEktJhZuV

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David Liew drdavidliew ( View Tweet)
It's all happening for biologic therapies in PMR! phase 2/3 double-blind RCT: - new PMR - n=36 - 11w PNL taper (until relapse - clinical not lab) - weekly sc TCZ for 16w vs placebo big benefit persists post-TCZ cessation real steroid sparing PMR-SPARE #ACR21 ABST0507 @RheumNow https://t.co/w8tgOPAtyJ
David Liew drdavidliew ( View Tweet)
In GCA, why might you target GM-CSF over IL-6? Entirely plausible TCZ might be leaving some Th1 stones unturned, esp: vascular remodelling downreg pathways Transcriptomics from toci/mavri-treated TAB show it's plausible beyond just theory... Cid group #ACR21 ABST0506 @RheumNow https://t.co/YephlzHOdj
David Liew drdavidliew ( View Tweet)
Gender differences in AS pts? IL-23R, IL-12R, IL-6R, JAK, STAT and TYK2 ⬇️regulated in men Small study of 20 pts, but could it guide targeted therapy based on gender?🤔 Abs#0050 https://t.co/OQHQCCzfuC #ACR21 @RheumNow

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Robert B Chao, MD doctorRBC ( View Tweet)

#ACR21 Abst#0269 ⭐️TCZ: ⬆️cholesterol, LDL, TG. ⬇️ hsCRP compared to TNFi. No ⬆️ risk of Reynold risk score (RRS) Take-away: good data on TCZ effect on lipids, but I wouldn't use RRS to calculate CVD risk on med that ⬇️ CRP @Rheumnow https://t.co/zMltktfHkS https://t.co/bwKXiGIi8a

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Eric Dein ericdeinmd ( View Tweet)
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