Upside Down with Tocilizumab in COVID-19

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Several recent reports offer conflicting views on the potential benefits and adverse outcomes of IL-6 inhibition with tocilizumab (TCZ) therapy in patients with severe COVID-19 infection.

An Italian study grabbed the headlines yesterday with a press release stating TCZ did not improve respiratory symptoms, ICU admissions or mortality rates when given to 126 COVID patients with early disease. The study, supported by the Italian Medicines Agency (Aifa), stopped enrollment (about 1/3 of projections) after an interim analysis found insufficient evidence that TCZ would be effective.  This report has not been published or undergone critical review.

Voclosporin Beats Standard of Care in Lupus Nephritis

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The high potency calcineurin inhibitor voclosporin plus standard of care was superior to standard of care alone in a phase III study of lupus nephritis known as AURORA.

Canakinumab First FDA-Approved Therapy for Adult-Onset Still's Disease

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Yesterday, the FDA approved canakinumab (Ilaris) as treatment for adult-onset Still's disease (AOSD), the first ever FDA approved drug for AOSD.

Canakinumab, an interleukin-1 inhibitor, was FDA approved in 2013 for use children (aged 2 years and older) with systemic juvenile idiopathic arthritis and has since been approved for use in other periodic fever disorders (e.g., FMF, CAPS, TRAPS, Hyper IgD syndrome).

Dexamethasone Reduces Mortality in Severe COVID

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Preliminary results released today shows dexamethasone (DEX), given to hospitalized, severly ill, COVID-19 patients, is capable of reducing mortality rates by one-third, with researchers calling this a “major breakthrough” in coronavirus management.

The results stem from a UK trial, called the RECOVERY trial, launched in March 2020, compared outcomes of around 2100 patients who were randomly assigned to DEX treatment compared with 4,300 patients not on DEX. 

Atherosclerotic Events on the Decline in SLE

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The prevalence of atherosclerotic vascular events among patients with systemic lupus erythematosus (SLE) today is considerably lower than in the past, analysis of multicenter data found.

Among patients enrolled in an inception cohort from 1999 to 2017, only 3.6% of patients had an atherosclerotic vascular event, at a rate of 4.6 per 1,000 patient-years, according to Murray B. Urowitz, MD, of the University of Toronto in Canada, and colleagues.

Methotrexate May Enhance Pegloticase Response in Gout

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For patients with gout exacerbations while on pegloticase (Krystexxa), adding methotrexate may help reduce uric acid levels, researchers suggested at the European League Against Rheumatism (EULAR) virtual meeting.

In a small open-label study of 14 patients experiencing acute gout attacks, use of the pegloticase/methotrexate combination reduced uric acid levels to near undetectable levels in 11 patients, reported John Botson, MD, medical director of Orthopedic Physicians Alaska in Anchorage. He noted that this was far below the 5 mg/dL level recognized as the threshold for development of inflammation that causes gout attacks.

Day 4 - Top 3 from EULAR 2020

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These were my top abstracts from Thursday, 4th of June at EULAR 2020:

Day 2 – Top 5 from EULAR 2020

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These were my top abstracts from Thursday, 4th of June at EULAR 2020.

Preventing COVID - Masks, Meters and Eyewear

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A Lancet systematic review and meta-analysis provides the basis for physical distancing and the value of making as measures to prevent infection with coronavirus 2 (SARS-CoV-2) or COVID-19.

The analysis included 172 observational studies, no randomised controlled trials and 44 relevant comparative studies involving 25 697 patients. 

Hydroxychloroquine Postexposure Prophylaxis for COVID-19 Fails

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NEJM has reported that the use of hydroxychloroquine did not prevent symptomatic COVID-19 infection when used within 4 days after SARS-CoV-2 exposure.

Currently for persons who are COVID exposed, the standard of care is quarantine and there is no known preventative therapy.

TNR Grand Rounds - Update on Biosimilars

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This week's Tuesday Nite Rheumatology featured Dr Jonathan Kay (U Mass) who gave an update on Biosimilars and took questions the subject. The program was moderated by Dr. Jack Cush.

FDA Approves Taltz for Non-Radiographic Axial Spondyloarthritis

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Today Eli Lilly announced that Taltz (ixekizumab) has received FDA approval for the treatment of adults with active non-radiographic axial spondyloarthritis (nr-axSpA).

First Look at COVID-19 Global Rheumatology Alliance Registry

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Gianfresco et al have published the first peer-reviewed analysis of COVID-19 infected, rheumatic disease patients entered into the Rheumatology Global Alliance registry; showing that a) rheumatic disease patient can be infected with COVID-19, b) that DMARD and biologic use has no apparent effect on outcomes and c) steroid increase and TNF inhibitor decrease the odds of hospitalization.

RheumNow Podcast - Rheumatic Patients with COVID (5.29.20)

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Dr. Jack Cush reviews the news and journal articles from the past week on RheumNow.com.

Targeting the Wnt Pathway Fails in OA

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The Wnt pathway modulator lorecivivint failed to meet the primary endpoint in a phase IIa study for knee osteoarthritis (OA), but showed promise in certain patient subgroups, researchers reported.

TNR Grand Rounds - Cytokine Storm Syndromes

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This week's Tuesday Nite Rheumatology featured Dr Randy Cron from the University of Alabama - Birmingham as he spoke and took questions on the immunology, immunopathogenesis and treatment of Cytokine Storm Syndrome, especially as they relate to COVID-19 and rheumatic disease patients. The program was moderated by Dr. Jack Cush.

Hydroxychloroquine Improves Survival in Lupus

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Hydroxychloroquine (HCQ) has dominated the news in recent weeks, because of poor outcomes reported when used in COVID patients. Yet, a recent report reaffirms what rheumatologists have known for years - that HCQ use is associated with better outcomes in systemic lupus erythematosus, including survival.