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2021 Rheumatology Year in Review

Jack Cush, MD

Our top 10 list of advances, game-changers, worries and those better medical practices that evolved during 2021.

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Best of 2021: FDA Puts Boxed Warnings on JAK Inhibitors

Jack Cush, MD

Based on the safety review of tofacitinib in Pfizer's Oral Surveillance (1133) study, the FDA has added serious boxed warnings to all three marketed JAK inhibitors (for inflammatory diseases) and formalized the recommendation that patients should be started on a TNF inhibitor (TNFi) before trying a JAK inhibitor. These recommendations apply to tofacitinib, baricitinib and upadacitinib.

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Best of 2021: Tofacitinib Safety Concerns

Jack Cush, MD

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

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Cancer,cells

Certain Cancers Increased with Autoimmune Diseases

Jack Cush, MD

Rheumatologists are well aware that inflammation and immune dysregulation are prime contributors to cancer risk, but do oncologists carry the same impressions? A large study from JAMA Oncology shows that patients with immune-mediated diseases (IMD) have an overall increased risk of cancer, especially in organ-specific immune-mediated diseases. 

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FDA.Safety.jpg

FDA Puts Boxed Warnings on JAK Inhibitors

Jack Cush, MD

Based on the safety review of tofacitinib in Pfizer's Oral Surveillance (1133) study, the FDA has added serious boxed warnings to all three marketed JAK inhibitors (for inflammatory diseases) and formalized the recommendation that patients should be started on a TNF inhibitor (TNFi) before trying a JAK inhibitor. These recommendations apply to tofacitinib, baricitinib and upadacitinib.

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jon.kay

Does Control of Inflammation Lower Cancer Risk?

Jack Cush, MD

Dr. Jonathan Kay's provocative video addresses whether the increased cancer risk associated with tofacitinib (Tofa) seen in the Pfizer Oral Surveillance (1133) study represents a real increased risk, an increased risk relative to a decreased risk with TNF inhibitors (TNFi) or an actual decreased cancer risk (unknown as there was no placebo comparator in this trial).

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Risk of Cancer w/ IgG4-related disease (IgG4-RD)? A meta-analysis of 10 studies shows compared to gen population, IgG4-RD has a higher risk of overall cancer(SIR 2.57), esp pancreatic (SIR 4.1) & lymphoma (SIR 69.2); but not lung or gastric cancer https://t.co/EzgMXIdFcL

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Dr. John Cush RheumNow ( View Tweet)

ICYMI: Does Control of Inflammation Lower Cancer Risk? https://t.co/OBMIdPki7O https://t.co/zV04iAOjAz

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Dr. John Cush RheumNow ( View Tweet)
Prof. Ami Shah: Patients with #scleroderma have an ⬆ risk of #cancer vs. general population 📌Data from 3 recent meta-analysis: Scleroderma pts have 1.4 to 1.8 fold increased risk of cancer @RheumNow #ACR21 https://t.co/4uQN6y3tIn
sheila RHEUMarampa ( View Tweet)
Dr. Ami Shah shares her approach to cancer screening in patients with #scleroderma👇 @RheumNow #ACR21 https://t.co/chmlGe4iyl
sheila RHEUMarampa ( View Tweet)
TIF1-y: most dominant target in #cancer assoc'd #dermatomyositis 🔷Associated with cancer in every racial group tested; no assoc'n w/ juvenile DM @RheumNow #ACR21 https://t.co/rPg1CQuNka
sheila RHEUMarampa ( 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 #Abstr1908 Potential prognostic biomarker for lymphoma in #sjogren. ISG15 (IFN-I) expression was consistently ⬆️in pts with lymphoma vs none, both in blood and salivary gland biopsy. Work needed re: relation to other markers, ethnicity @RheumNow https://t.co/8VYYEXpXSw https://t.co/ZIkpx5kUfu

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Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
Dr Ami Shah - Scleroderma & Cancer: 🛑 ⬆️ risk of ca around the time of dx in SSc patients with RNA-pol-III (especially first 5 years after dx), anti-Th/To protective? 🛑Her approach for ca screening in newly diagnosed with SSc pts and red flags as below #ACR21 #ACRambassador https://t.co/2VcWn2UInm
Didem Saygin, MD didemsayginmd ( View Tweet)
Dr. Fiorentino on cancer risk stratification and screening in myositis. Come chat at noon in the Myositis Community Hub to learn more! #ACR21 #ACRAmbassador https://t.co/I0iQuPAuOl
Veena Katikineni VeenaRheumMD ( View Tweet)
How do RA pts go with ICI cancer therapy? @VUMCRheum audit reflects overall prev experience: - approx 50% flare (?some reflect DMARD W/H) - flares overwhelmingly managable - few (1/19 here) cease ICI due to RA flare RA pts deserve best cancer Rx too!! #ACR21 ABST1523 @RheumNow

David Liew drdavidliew ( View Tweet)

This case is from the hypereosinophilic syndrome talk. This was NOT EGPA! It was cancer. Be careful! #ACR21 @RheumNow https://t.co/UhdpeHBfOE
Richard Conway RichardPAConway ( View Tweet)
Are there people looking at steroid-sparing therapy as irAE treatment or prevention? @CCalabreseDO: are there ever #ACR21 irAE Study Group @RheumNow (also @NAbdelwahabMD @ReidMDMPH on stage) https://t.co/CLmNaLB68O
David Liew drdavidliew ( View Tweet)
Either we need to review the Yearly PAP cervical screening in SLE women or work hard to improve patient awareness. Suspect the latter as time between tests was over 4 years late 😱 and 2.7% developed cancer #ACR21 #Abstr0133 @RheumNow https://t.co/wm01MfoFjf https://t.co/blD8WafZsE

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Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
Knowledge Bowl at #ACR21 ⭐️The first lung fibrosis described in Sjogren's with lung biopsy showing benign polyclonal lymphocytes and plasma cells with a risk for malignant transformation. ➡️Lymphocytic Interstitial Pneumonia @RheumNow

Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)

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