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FDA Puts Boxed Warnings on JAK Inhibitors
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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Does Control of Inflammation Lower Cancer Risk?
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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ACR21 Best Abstracts - Day 2
The RheumNow faculty reporters have been scouring and reporting on the best abstracts from the ACR. Here is a sampling of their choice abstract presentations reported during ACR 2020 Day 2 (#ACRbest).
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ICYMI: Does Control of Inflammation Lower Cancer Risk?
https://t.co/OBMIdPki7O https://t.co/zV04iAOjAz
Links:
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
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
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)
What to do if pt on a TNFi develops cancer? Can you safely restart TNFi later? Depends on cancer, timing - how long ago was cancer, Rx and patient preference. Data diff from RABBIT registry vs British bio registry @RheumNow #ACR21 #ACRBest 7S413 Have a look https://t.co/q9SFKlFJzg
Janet Pope Janetbirdope ( View Tweet)
Very interesting talks by Dr. Kim and Dr. Hyrich on DMARDs and Cancer risks
#ACR21 @RheumNow https://t.co/Dl5WPo7mmj
Akhil Sood MD AkhilSoodMD ( View Tweet)
This feels like an excellent starting point for Tuesday's ORAL Surveillance malignancy discussion.
RWE Cohort: HR 1.01 (0.83-1.22)
RCT-dup Cohort: HR 1.19 (0.86-1.64)
ORAL Surveillance: HR 1.48 (1.04-2.09)
Interesting day 4 ahead!
great talk @SeoyoungCKim #ACR21 7S413 @RheumNow https://t.co/YSau21goMr
David Liew drdavidliew ( View Tweet)
Abst0569 #acr21 @RheumNow mortality in SpA:⬆️ overall mortality in AS (RR 1.64, 95% CI: 1.49-1.80,) but not PsA (RR: 1.12, 95% CI: 0.96-1.30). CV, resp & infection specific mortality significantly higher for PsA Cancer related mortality in PsA not higher than the gen pop
Olga Petryna DrPetryna ( View Tweet)
