Immune checkpoint inhibitors (ICIs) have dramatically improved outcomes in numerous cancers but have been hampered by a growing spectrum of immune-related adverse events (irAEs). Rheumatic complaints may be less frequent than other irAEs associated with ICI in cancer patients. 

Dr. Jack Cush reviews the news and journal reports from the past week on RheumNow.com. This week, neuroimmunology leading to therapy, the cold shoulder approach and Regulatory updates from the FDA.

The incidence and mortality of cancer among autoimmune diseases (AID) was studied in a large Chinese cohort, demonstrating that while onset time and risks vary, there is an increased risk of malignancy in AID.

In an editorial in the current edition of the NEJM, Dr. Jasvinder Singh comments on the Oral Surveillance trial (Ytterberg et al.), a 4-year randomized, open-label, noninferiority, postauthorization, safety end-point trial, in high risk active rheumatoid arthritis patients over age 50 years.

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

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.

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

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. 

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.

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).