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RheumNow Podcast - Unwillingness to Change Therapy (11.19.21)

Jack Cush, MD

Surely you’ve seen this or been plagued by this patient, one that is not doing well, in need of a new regimen; you outline it, timeline it, define the side effects and send them off with a new prescription..

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An Old Friend – Methotrexate in Psoriatic Arthritis

Pedro Castillo

Methotrexate (MTX) remains one of our most used and reliable tools against a variety of rheumatic diseases, including PsA. When the time comes, as it often does, to escalate from a MTX-monotherapy approach, we have several options. In clinic, initiation of these other medications has often been in the form of addition rather than substitution. But what do the patients want, and how much more is the MTX adding in those cases?

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Perspectives on CV safety: JAK inhibitor (Tofacitinib) and TNF inhibitors

Janet Pope, MD, MPH, FRCPC

Safety comparisons of JAKi (tofacitinib) vs. TNFi from Oral Surveillance showed that, in patients with active RA on MTX and aged >50 years with one or more CV risk factors, that there was numerically more MACE events, malignancies, and VTE especially in higher dose.

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RheumNow Podcast - ACR 2021 Rehash (the good stuff..)

Jack Cush, MD

The ACR 2021 meeting has concluded. Dr. Jack Cush recounts a few more great abstracts from this past week’s virtual meeting.

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Can "Ultra-low" dose Rituximab work for RA?

Eric Dein, MD

The REDO trial presented data in abstract 1443 in an oral presentation challenging how low we can go with rituximab for rheumatoid arthritis. Their study randomized 118 patients with rheumatoid arthritis to 1000 mg, 500 mg, and "ultra-low" dose 200 mg.

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Day 4 Report from ACR21

Jack Cush, MD

My favorite three presentations from day 4 (Tuesday) at ACR 2021 included the following.

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ACR21 – Day 3 Report

Jack Cush, MD

Hitting the home stretch, day 3 presentations were big! Here are a few of my favorites: secukinumab efficacy in juvenile PsA; VEXAS - predicting poor outcomes; and the FDA Safety Update session.

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Monitoring Infliximab Drug Levels Improves Efficacy

Robert Chao, MD

Should we start considering therapeutic drug monitoring when prescribing TNFi for treatment of our rheumatologic conditions?

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This podcast is devoted to discussing patient satisfaction and factors important in their willingness or unwillingness (resistance) to change therapies. https://t.co/eVLlD8gEIM https://t.co/B24NWnGLHu

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Dr. John Cush RheumNow ( View Tweet)
ICYMI: Filgotinib (Jyseleca) was approved by European Commission approved for EU use in adults with moderately to severely active Ulcerative colitis (not responding to conventional therapy or a biologic). Rec based on Phase 2b/3 SELECTION trial. https://t.co/9VbCJse6Tr

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Dr. John Cush RheumNow ( View Tweet)

Infections in ORAL Surveillance: Drs. Kevin Winthrop and Jonathan Kay https://t.co/GtMtUh33QE https://t.co/yjJngF25Y4

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Dr. John Cush RheumNow ( View Tweet)
Retrospective chart review of rheumatic irAE patients: Persistent rheumatic irAE activity 🔼received GC Inflammatory arthritis pts 🔼risk of persistent rheumatic irAE Risk factors for mortality➡️tumor progression➕ continued Rx GC at last follow-up Abst#1516 #ACR21 @RheumNow https://t.co/KusNaVlEXp
swethaann23 swethaann23 ( View Tweet)
Abst 1517 Weinmann & colleagues studied prevalence of autoantibodies in Melanoma pts treated w/ ICI & developed rheumatic IRAE - Most common rheumatic IRAE = inflammatory arthritis - Higher prevalence of ANA in those tx w/ chemo prior to ICI #ACR21 @RheumNow https://t.co/7qgogSMjUr
Akhil Sood MD AkhilSoodMD ( View Tweet)
#ACR21 Ab#1941: ORAL Surveillance VTE risk ▶️Tofa 10 BID risk > 5 BID > TNFi for VTE, DVT, PE ▶️Age, male, obesity, HTN, h/o VTE, oral contraception/HRT, steroids, antidepressants were risk factors @RheumNow https://t.co/JOKNyYVZfX https://t.co/mTkgkwPIT6

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Eric Dein ericdeinmd ( View Tweet)
#ACR21 Ab#1939: Tofa CV Outcome (STAR-RA) ▶️Pooled data does not show ⬆️ risk of CVD ▶️Trend in pts w prior CVD -HR 1.27 (0.95-1.7), cannot r/o CVD risk in pts w risk factors Less clear than oral surveillance data, but concerns in those w risks https://t.co/JOKNyYVZfX @Rheumnow https://t.co/GGYJfxcqhc

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Eric Dein ericdeinmd ( View Tweet)
ORAL Surveillance malignancy risk @RADoctor . Numerically higher at both doses tofacitinib compared to TNFi . Abstr#1940 #ACR21 @RheumNow https://t.co/uc2k5EaiRq
Richard Conway RichardPAConway ( View Tweet)
STAR-RA, CV risk large insurance datax3 tofa vs TNFi all comers: HR 1.01 (0.83-1.23) one CV RF + any MTX: HR 1.24 (0.90-1.69) prev CVD: HR 1.27 (0.95-1.70) not sig but surely okay to say baseline CV risk + tofa makes me a little nervous? @SeoyoungCKim #ACR21 ABST1939 @RheumNow https://t.co/LmmL5zgv9u
David Liew drdavidliew ( View Tweet)
Another study linking long term GC and CV risk in RA! Medicare data >65yo 130000+ pts 1-year incidence CV ⬆️ as follows: 📍Dose ≤5mg 1.4% 📍Dose 5-10mg 1.7% 📍Dose >10mg 1.9% Not replicated in younger pts (Optum data) #ACR21 #Abst1915 @RheumNow https://t.co/DLXdfvfiBW
Aurelie Najm AurelieRheumo ( View Tweet)
#ACR21 Abs#1915 👉🏼Chronic steroid use in older adults on stable DMARD therapy assoc w/ ⬆️CV risk 👉🏼Risk even present among older adults receiving low dose ≤5mg/day 👉🏼Larger studies needed in younger healthier adults @RheumNow https://t.co/Lsj5YBz7IG
Mrinalini Dey DrMiniDey ( View Tweet)
Long-term low dose glucocorticoid use associated ⬆️cardiovascular risk. Clear effect in Medicare population (older), not evident in Optum (younger). Dose dependent. Abstr#1915 #ACR21 @RheumNow https://t.co/oFet3Hhsfo
Richard Conway RichardPAConway ( View Tweet)
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