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Is IL-23 Better than IL-17 Inhibition in Psoriasis?

Jack Cush, MD

Data presented at the recent American Academy of Dermatology meeting suggests that interleukin (IL)-23 inhibition with risankizumab was more effective than the IL-17 inhibition (secukinumab) based on a 52 week randomized head-to-head trial in moderate to severe psoriasis patients.

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Tocilizumab May Benefit COVID-19 Pneumonia

Jack Cush, MD

A retrospective, observational study published in Lancet Rheumatology has shown that tocilizumab (TCZ) may reduce the risk of death or the need for mechanical ventilation in severe COVID-19 pneumonia. This observational study included adults, with severe COVID-19 pneumonia, who were hospitalized between Feb 21 and March 24, 2020. All were on the standard of care (ie, supplemental oxygen, hydroxychloroquine, azithromycin, antiretrovirals, and low molecular weight heparin), and a non-randomly selected subset of patients also received TCZ.

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Protective Benefit of Colchicine in COVID-19 Infection

Jack Cush, MD

Colchicine has been advocated as a potential anti-inflammatory intervention in patients with the coronavirus 2 infection and clinical trials have been developed to assess its effect in early COVID-2 infection.  JAMA has published a randomized clinical trial showing that low dose colchicine had less clinical deterioration without significant changes in biomarkers, such as high-sensitivity cardiac troponin and C-reactive protein.

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Adverse Events With Rheum Biologics Rise With Age

RheumNow

Among patients with rheumatic diseases, age and female sex were important factors associated with the development of a first adverse event after initiating biologic treatment, Spanish researchers reported.

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Hydroxychloroquine Fails as Postexposure Prophylaxis for Covid-19

Jack Cush, MD

Add this to the list of hydroxychloroquine (HCQ) letdowns in managing COVID-19 treatment or risk - prophylaxis with HCQ fails to prevent COVID-19 infection in those exposed to the SARS-CoV-2 virus. 

NEJM has reported a prospective, randomized, double-blind, placebo-controlled trial from the US and Canada wherein adults with household or occupational exposure to someone with confirmed Covid-19 were treated with either placebo or HCQ within 4 days of exposure.

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Series of 11 severe COVID-19 pts Rx w/ Anakinra. 7/11 recv anakinra w/in 36 hrs - none required ventilation. 4 got anakinra after 4days of Resp Sx & required ventilation; 1 died. Pts were SARS‐CoV‐2+, w/ fever, ferritin >1,000 ng/mL & acute resp failure. https://t.co/vegsJPrSGp

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Schulz-Koops reports 2 #RA patients Rx with RTX who died from COVID pneumonia and ARDS. Both were older, had comorbidities (COPD, HTN, OP) and had received last RTX either 2 wks and 6 mos before COVID infection onset; both had nl IgG levels https://t.co/j043Tggdbg

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The CHMP of the European Medicines Agency has recommended the label expansion of IL-17 inhibitor, Cosentyx (secukinumab) for the treatment of moderate-to-severe plaque psoriasis in children and adolescents aged 6-18 years. https://t.co/1qYL5ASkrg

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Fasinumab, nerve growth factor inhibitor, studied in a phase II trial of 421 moderate-to-severe OA (knee or hip) pts x36 wks & show to be better than placebo. But FAS had more AE (17% v 10%), Jt Surgeries (7% v 1%) and destructive arthropathy in 1 FAS pt https://t.co/eHvYrByF1Z

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60,596 RA Medicare patients with MBDA testing showed in those not taking biologic/JAK inhibitor Rx, the odds of adding new Rx was 9.0% (with a low MBDA), 11.8% (moderate MBDA), and 19.7% (high MBDA, p < 0.0001). Higher MBDA yields more Drug switches https://t.co/Tu7jChQi06

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The RheumNow Podcast is Up! Lupus Mortality Declines, But… Review of SUA and cancer; IL-12/23 and SLE; TCZ and Behcets, Pregnancy SI MRI, VTE w/ Jaks; COVID; Colchicine. Watch it here> https://t.co/2V7TbaAsOp or listen on iTunes or SoundCloud https://t.co/XMps2GTgeD

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Retrospective study of 2369 patients with Kawasaki disease examined different doses of aspirin showing lower ASA doses of 20–29 mg/kg/day was as effective as 30–50 mg/kg/day in preventing coronary artery aneurysms with no change in IVIG resistance https://t.co/kJgkSSpjyw

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J&J announced that is discontinuing its phase 3 trial of ustekinumab in #SLE. An interim analysis of the 516 pt LOTUS trial showed no new safety concerns. Study was halted for lack of efficacy. A subsequent LOTUS-C trial in China has been suspended. https://t.co/iN5trI0V71

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Study of 1362 #RA patients given TNF inhibitors, abatacept, tocilizumab between 2011-17 finds TCZ had best survival regardless of age; ABA had lowest D/C for adverse events & disease activity improved more with TNFi. https://t.co/7RRO9M4Wf0

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Tocilizumab may be effective in refractory ocular-, neuro-, vasculo-Behcet's. Study of 47 Behcet's pts Rx w/ TCZ - good at ocular (24/25), CNS (6/6), vascular (7/7) & amyloidosis(2/2) but less effective w/ oral/genital (8/21), skin (6/14) or joints (4/11) https://t.co/lKY8D706bi

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TNFi, ABA, TCZ Retention rates looked at in 1362 RA according to age. For < 65 years, 3-year retention was best for TCZ 69%. For pts 65–74 years, retention rates highest for TCZ . For ≥ 75 years, 3-year retention rates best for ABA & TCZ (63% & 58%). https://t.co/7RRO9M4Wf0

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Pt w/ severe systemic JIA & recurrent macrophage activation syndr underwent whole exome sequencing & found to have gain in function CASP1 variant leading to inflammasome & NF-κB hyperactivation (hi IL-6, IL-1β IL-18, IFNγ) Rx w/ IL-1 & IL-6 inhib https://t.co/SE3p5CTEak

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A negative RCT shows yearly treatment with Zolendronic acid fails to change tibiofemoral cartilage volume (by MRI) in Knee Osteoarthritis patients with bone marrow lesions. 223 knee OA pts recv ZOL vs PBO x24 mos , w/ no change inVAS pain (-11.5 vs -16.8) https://t.co/N7N0rL8iCX

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NEJM case report of PD-1 inhibitor induced immune related colitis successfully treated with tofacitinib 10 mg bid for 30 days - patient improved after 5 days of TOFA. https://t.co/skfU6TKnlK

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WHO global safety database shows increased risk of DVT & PE with tofacitinib & baricitinib, who were likely to be older with preexisting VTE risk. In EU, TOFA risk for DVT/PE was OR 2.3; BARI risk was OR 3.4. No VTE risk for BARI in US, TOFA 2.0 VTE risk https://t.co/PUBUzfrydn

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