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Are We Overcautious With TNF Inhibitors in Pregnancy?

MedPage Today

What may seem like a prudent approach to treatment of inflammatory bowel disease (IBD) in pregnant women actually represents an overabundance of caution, suggested researchers who found no increased risk from tumor necrosis factor (TNF) inhibitors.

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Heavy Metal Rheumatology (9.23.2022)

Jack Cush, MD

Below are this week’s highlights from RheumNow, as discussed by Dr. Jack Cush. Thanks to all of you for your kind comments and great reviews of our weekly podcast. Please let us know how we can improve by emailing me or recording your suggestion using the "Ask Cush Anything" link on our website.

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USPSTF Recommends Screening for Anxiety and Depression

Jack Cush, MD

The U.S. Preventive Services Task Force has recommended that general practitioners actively screen and identify anxiety and depression in all adult patients under 65 yrs.

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Hydroxychloroquine Dosing and SLE Flares

Jack Cush, MD

A cohort study examining hydroxychloroquine dosing in patients with SLE suggests that HCQ doses of 5 mg/kg per day or less, in accordance with current ophthalmology and rheumatology guidelines, was associated with a higher risk of lupus flares, including moderate or severe lupus flares.

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CD19 CAR T Cell Therapy in SLE (9.16.2022)

Jack Cush, MD

The big news this week: the approval of deucravacitinib (a new class of drug?) for psoriasis; the 2022 ACR guidance on glucocorticoid-induced osteoporosis; a national poll of older adults over the age of 50 who claimed self-reported or doctor-diagnosed arthritis; and much more. Let's review these and other news, journal reports and announcements from this past week.

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Does Methotrexate Use Lead to Melanoma?

Jack Cush, MD

A systematic review suggests that low-dose methotrexate (MTX) use is associated with an increased melanoma risk, but the absolute risk increase could be considered negligible.

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2022 New ACR Guidance on Glucocorticoid-Induced Osteoporosis (GIOP)

ACR

The ACR has updated this guideline and includes recommendations on abaloparatide (PTHrP) and romosozumab, which are newly available since the ACR’s 2017 GIOP guideline.

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Disease Activity Drives Adverse Pregnancy Outcomes in RA

Jack Cush, MD

Two large RA registries have shown that pregnancy outcomes in rheumatoid arthritis (RA) patients is more related to RA disease activity rather than treatments use to control RA. 

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VTE Risk from Swedish Rheumatology Quality Register - VTE Prevalnce/1000PY TNFi 5.15; JAKi 11.33; Gen Pop 3.3. VTE adj HR JAKi vs TNFi =1.73 (1.24, 2.42); PE HR 3.21 (2.11, 4.88) and DVT HR 0.83 (0.47,1.45) https://t.co/WclcFpX3aI https://t.co/r1FXSZNcYJ

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Hydroxychloroquine Dosing and SLE Flares JAMA cohort study examining HCQ dosing in patients with SLE suggests that HCQ doses of 5 mg/kg per day or less, was associated with a higher risk of lupus flares, including moderate or severe lupus flares. https://t.co/1krevZo64c https://t.co/XEybtcFvNR

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Dr. John Cush RheumNow ( View Tweet)
STAR-RA study - real world claims data shows tofacitinib doesnt increase malignancy risk. Study of 83,295 pts (10,504 TOFA). Risk of malignancy w/ TOFA not increased (HR 1.01) w/ RWE or RCT-duplicate cohort (HR 1.1; 95% CI 0.85, 1.62) https://t.co/9YWmXBTkWf

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RINOMAX Trial studied single dose of 500 mg rituximab IV in myasthenia gravis - 47 MG pts randomized to RTX or PBO, after 4 mos RTX response (71% vs 29%) superior to PBO. Further studies are needed https://t.co/ffko7uMpk7

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Colchicine vs cimetidine in PFAPA (Periodic fever, aphthous stomatitis, pharyngitis, adenitis) syndrome. 72 pts given COL vs CIM x 3 mos: # of febrile attacks was significantly decreased by both Rx (noninferior to each other) https://t.co/HkmzwGNwFC

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Open label, multicenter study of 70 Psoriasis pts treated w/ apremilast shows no change in aortic vascular inflammation (FDG-PET) at wks 16 & 52, but did decr. several cardiometabolic biomarkers (IL1b, ferritin) & 5-6% loss of SC fat https://t.co/iJOgZ5kHLb

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Hydroxychloroquine Dosing and SLE Flares JAMA cohort study examining HCQ dosing in patients with SLE suggests that HCQ doses of 5 mg/kg per day or less, was associated with a higher risk of lupus flares, including moderate or severe lupus flares. https://t.co/B5HqxWDqD3 https://t.co/4crIFBV9XP

Links:

Dr. John Cush RheumNow ( View Tweet)
STAR-RA study - real world claims data shows tofacitinib doesnt increase malignancy risk. Study of 83,295 pts (10,504 TOFA). Risk of malignancy w/ TOFA not increased (HR 1.01) w/ RWE or RCT-duplicate cohort (HR 1.1; 95% CI 0.85, 1.62) https://t.co/GIIvs2cK3s

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Propensity matched pairs (n=237 872) of perioperative pts - gabapentin users and nonusers shows perioperative gabapentin use had significantly more delirium (RR 1.28), antipsychotic Rx (1.17 ) & pneumonia (1.11) vs nonusers post surgery https://t.co/UAZs7Vqy6O

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Dr. John Cush RheumNow ( View Tweet)

Does Methotrexate Use Lead to Melanoma? A systematic review suggests that low-dose methotrexate (MTX) use is associated with an increased melanoma risk, but the absolute risk increase could be considered negligible. https://t.co/aLFBoB7M48 https://t.co/A1sHLaguqy

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Dr. John Cush RheumNow ( View Tweet)
Open label, noninferiority study TNFi withdrawal in 64 PsA & 58 axSpA pts. 2/3 tapered by dz activity T2T strategy (N=81) & 1/3 continued TNFi. At 12 mos. LDA seen in 69% w/ Tapering (~avg 53% dose) vs 73% no-tapering group (91% dose) https://t.co/K6WFaesyRt https://t.co/zqo6nVGtqW

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The 2022 ACR abstracts are published and posted for you. Let the Learning begin! https://t.co/ZqMAc8jV3U https://t.co/3iCGnzsPI5

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