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US Trends in RA DMARD Use 2017-2021
A trend analysis of DMARDs shows that only half of rheumatoid arthritis (RA) patients are taking DMARDs, and that the COVID-19 pandemic substantially affected DMARD use. Despite numerous DMARD advances and evolving treatment guidelines since 1990, older therapies are still commonly used and the latest agents make up a small percentage of overall DMARD use.
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Again, a High Mortality with Depression and RA
Last week we reported on a Korean study showing a 66% elevated mortality risk in RA patients (n=38,487) with depression.
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9 Facts about Leflunomide
Medscape has published an informative review of leflunomide, drawn from Dr. Eric Ruderman’s recent lecture on the subject at the February RWCS meeting in Maui.
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Hidradenitis Suppurativa-Related Autoinflammatory Syndromes
Hidradenitis suppurativa (HS) is a suppurative inflammatory skin disorder that is considered to be autoinflammatory by many. HS includes a specturm of disorders, linked by suppurative (or psoriatic) skin disease and potentially genetics.
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Dutch study of 586 RA pts on bDMARDs found more nonserious infections (NSIE) (77/100PYs) than serious infx (SIE)(1.3/100Pys). Upper respiratory tract infections were most frequent with recurrence rate that remained stable over time https://t.co/zwELL2yevG https://t.co/GLbidGvjp3
Dr. John Cush RheumNow ( View Tweet)
DANBIO #RA registry study: in 21,982 Rx starts (96K PtYrs) saw 1423 cancers w/ no overall increase in cancer risk with tocilizumab, sarilumab, abatacept, or rituximab (HRs from 0.7–1.1). No diff betw ABA vs TNFi (HR 1.41) nor HEME CA RTX vs TNFi (HR 0.09) https://t.co/mIEqALnnwI https://t.co/N1v3TzuBGm
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Chinese SLE registry study of 350 SLE-TP (low plts) pts - 55% were aPL Ab+ (who had lower Plts @baseline (61K vs 76k). aPL+ SLE-TP pts w/ higher relapse rate (58% vs. 44%, P=0.009) & lower complete response rate. > more aPLs--> increased relapse rates https://t.co/Mb2YhsniVJ https://t.co/92QRWICcB4
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JAMA Review of DMARD Use in Rheumatoid Arthritis
JAMA has reviewed the "2022 EULAR Recommendations for the Management of Rheumatoid Arthritis With Synthetic and Biological Disease-Modifying Antirheumatic Drugs".
https://t.co/pJLriraWqq https://t.co/JElMzDyeMs
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COX-2 (on the left) have lower ulcer risk than COX-1 (to the right) NSAIDs. @BCryer https://t.co/Xfm7xJkvzd
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High risk pts on NSAIDs need prophylaxis!! @bcryer https://t.co/NAnHtkTNvL
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Endoscopy and Worry are indicated in the face of DYSPEPSIA and any of these: @BCryer https://t.co/6TabKhiLPO
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Testing for H. Pylori. Serologic tests are OK but after Rx eradication, 25% of pts will remain positive for H. Pylori. @BCryer
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Multiple Rx options to treat H. Pylori - Dr. Cryer recs regimens of 14ds; top line w/ bismuth is most recommended. (most effective is the one the patient will actualy take!) @BCryer https://t.co/f6836Ga1Fz
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H. Pylori is usually acquired during childhood, remains dormant until activated years later. Is assoc w/ PUD and gastric cancer, not dyspepsia. Baylor Univ Grand Round By Dr. Byron Cryer @BCryer https://t.co/KXZfigVYX9
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Mixed Long-term Effects of Calcium and Vitamin D in Postmenopausal Women
https://t.co/u2cf5hmTAE https://t.co/A4kdwG6eRm
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JAK-pot: 46913 Rx courses on JAKi, TNFi, other MOA. Rx D/Cs for AEs:
- TNFi = JAKi (HR 1.0)
- Other MOA > JAKi (HR 1.11)
- TNFi < tofacitinib (0.81)
- TNFi > baricitinib (1.15)
- TNFi < JAKi; if >65yrs w/ CV risk (0.79) https://t.co/N5XnPjxAXO https://t.co/AnoKM7fzM7
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What do you know about monogenic and polygenic autoinflammatory diseases? Join Drs Liebowitz and Mehta as they review the challenges of these conditions. https://t.co/EqJRXSzrEs https://t.co/z5yuHDXUZ3
Links:
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Effective Treatments for Still's Disease
A systematic review of pharmacological treatments for adult-onset Still disease (AOSD) supports the efficacy of tocilizumab (TCZ), anakinra (ANK), and canakinumab (CNK).
https://t.co/Qi98OXyoLJ https://t.co/DCgXfs0Bot
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Depression and RA
Dr. Jack Cush reviews the news, journal reports and regulatory approvals from the past week.
https://t.co/nJZD4D2ByC https://t.co/ET3Xp9cK62
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Vaccinations NOT linked to SLE risk. 17 studies (45 million) w/ F/U up to 2 yrs. No signif SLE risk:
- all vaccinations (OR=1.1; CI 0.86–1.5)
- HBV vax (OR=2.11; 1.11-4)
- HPV (OR=1.4; 0.88–2.3)
- Flu (OR=0.96; 0.82–1.1)
- COVID (OR=0.44; 0.18–1.2) https://t.co/YpxSYL97DM https://t.co/hsytm9UpDC
Dr. John Cush RheumNow ( View Tweet)