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Selective Biologic Responses in Seropositive RA

Jack Cush, MD

The Journal of Rheuatology reports a pooled analysis of patients from 16 observational RA registries that examined the association between seropositivity (RF or ACPA) with biologic DMARDs responses; they showed better clinical responses when seropositive RA patients receive abatacept (ABA) o

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RheumNow Podcast – The Bad News That’s Fit to Print (8.21.20)

Jack Cush, MD

Dr Jack Cush reviews the news and journal reports from the past week on RheumNow: filgotinib rejection, delays in diagnosis, metformin benefits COVID, Abx and IBD, and UPA beats MTX.

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Canakinumab Tapering in Still's Disease

Jack Cush, MD

You can reduce - but not stop - canakinumab therapy in patients who are in complete clinical remission in children with systemic juvenile idiopathic arthritis.

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Filgotinib Decision Delayed by FDA

Jack Cush, MD

On August 18th, Gilead and Galapagos received a complete response letter from the FDA, which will delay consideration of filgotinib for the treatment of moderate-to-severe RA.

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Upadacitinib is Superior to Methotrexate in Early RA

Jack Cush, MD

In a head-to-head trial against methotrexate, JAK1 inhibition with upadacitinib was shown to be more effective in early, DMARD-naive RA patients. Here are the primary results.

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Metformin as cotherapy in RA? It lowers RA risk in animal models. >2500mg/d lowers risk incident RA in women. Japanese study shows it suppresses osteoclastogenesis and upregulation of inflammatory cytokines, protease and growth factor genes. https://t.co/UEDMgtqLZG

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Dr. John Cush RheumNow ( View Tweet)

Study of 1,631 incident RA & 3283 controls shows respiratory disease assoc with risk of RA, irrespective of RF & CCP and mostly in nonsmokers. aOR increased for chronic upper (1.4), acute lower (2.4) & chronic lower (1.6) Resp Dz, stronger for ACPA/RF+ https://t.co/C1hA631PIW

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Dr. John Cush RheumNow ( View Tweet)

Telemedicine: What's Changed and What Needs to be Addressed? An update on legislative changes, uncertainties, and the care gap post COVID https://t.co/HRAsEP7IL6 https://t.co/X6PL0W4tI7

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Dr. John Cush RheumNow ( View Tweet)
Gilead/Galapagos gets a setback for filgotinib, its JAK1 inhib, that was poised to be the next approved RA drug by FDA. Instead the FDA issued a complete response letter; citing concerns over sperm studies (MANTA, MANTA-RAy) & 200 mg dose. Delay till 2021? https://t.co/H0rLjOMXq8 https://t.co/vb4FDUUVoS

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Dr. John Cush RheumNow ( View Tweet)
RheumNow Podcast - The Bad News That's Fit to Print (8.21.20) Dr Jack Cush reviews this week highlights filgotinib rejection, delays in Diagnosis, metformin benefits COVID, Abx and IBD, and UPA beats MTX https://t.co/1oZtU14VOB https://t.co/rcWlbYVKYn

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Dr. John Cush RheumNow ( View Tweet)
ATS Abstract: n=616 survey contrasts rheums (57%) & pulmonologists (43%) beliefs on RA associated ILD. Both preferred to use steroids, MMF, RTX for RA-ILD, but Rheums tend avoid ADA & LEF. Rheums (17%) & Pulms (24%) think MTX a risk factor https://t.co/W5gbu84FBv

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Dr. John Cush RheumNow ( View Tweet)

Metanalysis of total elbow arthroplasty in RA - 38 studies, 2,118 TEAs w/ mean F/U of 819 mos - the implant failure & complication rates were 16% & 24%. Aseptic loosening was most common failure (9.5%). Higher failures in younger pts & unlinked design https://t.co/Pq2N1Kku60

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Dr. John Cush RheumNow ( View Tweet)

@RheumNow its time we stopped “seroneg RA” which are many diseases, like ANCA pos Vasculitis we should have ACPA pos RA and others - how many viral arthritides in our country “doing great” on SZP, PLAQ, or low dose MTX and reluctant to stop? #RA #Seronegative

Peter Nash drpnash ( View Tweet)

Mayo clinic: Theres a delay in diagnosing Seronegative RA - 1st joint swelling to diagnosis of RA was 187 days for seroneg vs 11 days for seropositive patients (P<.001). Seronegative RA less likely to achieve remission (28% vs 50% at 5 years) (P=.007) https://t.co/Hgewjmt1CL

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Dr. John Cush RheumNow ( View Tweet)

Are there delays in Dx-ing RA? 2019 UK NHS study shows median delays from 1st Sx to seeing a rheumatologist was 27 weeks, with 20% seen w/in 1st 3 mos. Includes a patient delay (5.4 wks), GP delay (6.9 wks) & hospital delay (4.7 wks) https://t.co/vwNALZKkiR

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Dr. John Cush RheumNow ( View Tweet)

Filgotinib Decision Delayed by FDA. Instead of being the next approved RA drug, the FDA issued a complete response letter; citing concerns over sperm studies and the risk/benefit behind the 200 mg dose. Delay till 2021? 2022? https://t.co/6MHiGtOxCM

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Dr. John Cush RheumNow ( View Tweet)

Forward study of 18,754 RA patients who experienced 1,801 CVD events and found CVD risk reduction with TNFi (HR 0.82 [95% CI 0.72-0.94]) and abatacept (HR 0.50 [95% CI 0.30-0.83]) compared to csDMARDs over & above MTX alone (use vs. non-use: HR 0.82) https://t.co/YVfKWjkvxU

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Dr. John Cush RheumNow ( View Tweet)

NY Times article about a "guy and aching legs". 48 yrs old w/ myalgias, wt loss, SOB, sinusitis, high inflammatory markers, pulmonary infiltrates, microscopic hematuria, red & swollen ears; but no fever/chills. You're a rheumatologist, you know the Dx. https://t.co/fbrRMNA5u4 https://t.co/JFOcM0MBxB

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Dr. John Cush RheumNow ( View Tweet)
RheumNow Podcast - The SARS-CoV-2 Update (8-14-20) Dr. Jack Cush highlights the latest numbers on COVID-19 and its impact on Rheumatic Patients. Also, Top 4 best sellers, new take on NR-Ax-SpA & enthesitis https://t.co/IJAHGynSNd

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Dr. John Cush RheumNow ( View Tweet)

The RheumNow Podcast is up: The SARS-CoV-2 Update with info on enthesitis, nr-Ax-SpA, UAB, Blockbuster Rheum Drugs and use of ACE inhibitors. Watch it here> https://t.co/1WUZQJajgW or podcast listen here>> https://t.co/IJAHGynSNd

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Dr. John Cush RheumNow ( View Tweet)

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