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All in the Family (8.23.2024)

Jack Cush, MD

Dr. Jack Cush picks highlight reports from the past week on RheumNow.com, with reports on the challenge of lupus nephritis, perplexing skin issues, you don't know JAK (about Tyk) and the value of a good family history.

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Sequential Belimumab and Rituximab in SLE

Jack Cush, MD

Could disease control in active systemic lupus erythematosus (SLE) patients be improved by the sequential use of subcutaneous belimumab (BEL) and intravenous rituximab (RTX)? A double blind trial has shown that sequential BEL and RTX was not superior to BEL alone in SLE.

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CARRA Consensus Treatment for Refractory Juvenile Dermatomyositis

Jack Cush, MD

CARRA has developed consensus treatment plans for the use of biologic disease-modifying antirheumatic drugs (bDMARDs) in patients with refractory, moderately severe juvenile dermatomyositis. Juvenile dermatomyositis is the most common form of idiopathic, inflammatory myositis in childhood, with an estimated incidence of 3.2 per million children per year in the United States.

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Lead with Lupus (8.2.2024)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal reports from this past week on RheumNow.com - leading with lupus because everyone wants to know about lupus!

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JAK Inhibitors Reduce Macular Degeneration

Mepage Today

Insurance claims data showed that patients with autoimmune disorders who took Janus kinase (JAK) inhibitors had lower rates of age-related macular degeneration (AMD), hinting that the drugs might treat the common eye disease.

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HBV reactivation w/ Anti-IL17, IL12/23, IL23 & JAKi. Metanalysis of pts w/ chronic HBV infection (HBsAg+ or detectable HBV-DNA) and prior HBV infection (HBcAb+, HBsAg neg) shows more reactiv w/ chronic HBV (14% vs 5%), similar betw classes (0-4%) https://t.co/5Jgehb5gNg https://t.co/o0TuLEsMm9

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Dr. John Cush RheumNow ( View Tweet)
JAKi an option for Still's Dz, especially refractory AOSD? Metanlysis of 9 studies (35 pts), Rx w/ either Tofa (17), Bari (14), Ruxo (4), Upa 1. Half had complete remission, 1/3 partial remission, 1/5 loss effect. Ruxolitinib 100% effective in AOSD w/ MAS https://t.co/3TKFNsj4v9 https://t.co/3yAXlcJ2sX

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Dr. John Cush RheumNow ( View Tweet)
Severe Alopecia Areata or Universalis - if you stop the JAK inhibitor, Hair loss occurs quickly, but can be recaptured. Severe Alopecia Areata. Substudy of the baricitinib BRAVE-AA1 RCT, 80% of those who D/C vs 8% of those continuing, lost BARI benefits https://t.co/YcfmegdvK6 https://t.co/GIwVy4ac6U

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Dr. John Cush RheumNow ( View Tweet)
FIRST registry of 1424 #RA pts found 732 achieving HAQ-DI <0.5 & 454 w/ pain VAS <4/10. Achieiing LDA in 1st 6mos predicted by seropositivity & JAKi use. Less likely were: older, failin ≥ 2 b/tsDMARDs, hi baseline HAQ& steroid use (not comorbidities) https://t.co/7y0uMV414j https://t.co/6aLPTzf5fm

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Dr. John Cush RheumNow ( View Tweet)
JAK Inhibitors Reduce Macular Degeneration Insurance claims data showed that patients with autoimmune disorders who took JAK inhibitors had lower rates of AMD, hinting that the drugs might treat the common eye disease. https://t.co/MuJpbGPqe8 https://t.co/hcp4W3wP8a

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Dr. John Cush RheumNow ( View Tweet)
JAK Inhibitors Reduce Macular Degeneration Insurance claims data showed that patients with autoimmune disorders who took JAK inhibitors had lower rates of AMD, hinting that the drugs might treat the common eye disease. https://t.co/bx0UCp0o3r https://t.co/FXSlcFHYXI

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Dr. John Cush RheumNow ( View Tweet)
AbbVie has submitted regulatory applications to both the FDA and the European Medicines Agency for Rinvoq (upadacitinib) to treat adult patients with giant cell arteritis (GCA) https://t.co/LqRcm2FEFV https://t.co/XEjjSNnOGt

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Dr. John Cush RheumNow ( View Tweet)
FDA adverse event study of JAKi in #RA assoc w/ signif more VTE, ischemic heart Dz, & tachyarrhythmias. 75,407 on JAKi vs 303,278 on biologics (TNFi, RTX, TCZ); JAK had more VTE (ROR=2.11), CVA (ROR=1.25), IHD (1.23), arrhythmias (1.15 ), esp in 1st yr. https://t.co/IVsGwqpiJK https://t.co/4epOHdNHbO

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Dr. John Cush RheumNow ( View Tweet)
FDA adverse event study of JAKi in #RA assoc w/ signif more VTE, ischemic heart Dz, & tachyarrhythmias. 75,407 on JAKi vs 303,278 on biologics (TNFi, RTX, TCZ); JAK had more VTE (ROR=2.11), CVA (ROR=1.25), IHD (1.23), arrhythmias (1.15 ), esp in 1st yr. https://t.co/BmNPk6zN6o https://t.co/fbzHQmPmH5

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Dr. John Cush RheumNow ( View Tweet)
RT @drdavidliew I have to say: upadacitinib looks very decent for GCA. Not a panacea, but it definitely does something & good safety during trial. Would love to eventually see: - H2H comparative effect vs toci, secukinumab - structural outcomes - long-term safety #EULAR2024

Dr. John Cush RheumNow ( View Tweet)

New indications for JAK inhibitors There are several new positive RCTs for JAK inhibitors. We are so familiar with RA, PsA, SpA, axSpA and non radiographic axSpA. https://t.co/yyayyPcN9L https://t.co/4IQfmvbg4G

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Dr. John Cush RheumNow ( View Tweet)
JAK inhibitors have been used as adjunctive therapy to reduce flammation arising with checkpoint inhibitor use in cancer (Hodgkins, Lung CA), using itacitinib w/ pembrolizumab or ruxolitinib & nivolumab improved trial outcomes https://t.co/eF6wO72D80 https://t.co/IFDYuI71X5

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Dr. John Cush RheumNow ( View Tweet)
Shingrix in upadacitinib + MTX RA, in SELECT-COMPARE RCT: data now out to 60w good humoral and cellular response in most, even without MTX withheld (&amp; good safety too) Important for our JAKi-treated patients to get the protection they need #EULAR2024 OP0020

Dr. John Cush RheumNow ( View Tweet)

Abbvie announced upadacitinib (Rinvoq) is approved for use in polyarticular JIA and Psoriatic Arthritis (in children 2 years of age and older who have had an inadequate response or intolerance to 1 or more tumor necrosis factor (TNF) blockers) https://t.co/gvRzYpFl5i https://t.co/uSISWG3foy

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Dr. John Cush RheumNow ( View Tweet)
JAK Inhibitors in GCA Trials are underway evaluating the potential benefits of JAKi in GCA patients who are refractory to standards of care. An observational real-world analysis of a small worldwide cohort suggests the utility of JAKi in GCA. https://t.co/d4IsqBgkxQ https://t.co/PIDhwzgNym

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Dr. John Cush RheumNow ( View Tweet)
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