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Bifunctional B-cell Targeted Therapy in IgG4-related Disease

Jack Cush, MD

A novel B-cell depletion trial, using obexelimab (a bifunctional, monoclonal antibody that binds CD19 and Fc gamma receptor IIb), has shown efficacy and safety in patients with active IgG4-related disease.

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Tofacitinib in Polymyalgia Rheumatica (EAST PMR Study)

Jack Cush, MD

An open-label, uncontrolled pilot trial has shown that JAK signaling is involved in the pathogenesis of PMR and that tofacitinib is as effective as glucocorticoids (GC) in patients with polymyalgia rheumatica (PMR).

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EULAR/ACR Guidance on Haemophagocytic Lymphohistiocytosis/Macrophage Activation Syndrome

Jack Cush, MD

A EULAR/American College of Rheumatology task force has established evidence based, up-to-date guidance and expert opinion on the evaluation, management and monitoring of patients with Haemophagocytic lymphohistiocytosis (HLH) and macrophage activation syndrome (MAS), with the primary intent to halt disease progression and prevent life-threatening complications from HLH/MAS.

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Infectious Risk with B Cell Therapies in Lupus

Jack Cush, MD

A UK registry study of moderate to severe systemic lupus erythematosus (SLE) patients showed that treatment with rituximab or belimumab was not associated with a greater risk of serious infection, when compared to standard of care therapy.

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ANCA-associated vasculitis: beyond therapy with rituximab?

Md Yuzaiful Md Yusof, MRCP(UK), PhD

Following the success of Phase 3 randomised controlled trials of non-renal and renal vasculitis, therapy with rituximab has tremendously improved the outcomes of AAV patients. However, some patients are unable to taper their glucocorticoids during rituximab therapy while others appear to be refractory to therapy, particularly those with EGPA. Hence, what are other current or future approaches beyond rituximab?

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EULAR 2023 – Day 2 Report

Jack Cush, MD

Day 2 at the international EULAR Congress meeting is always bigger and busier. There were sessions on JIA therapies, crystal arthritis, novel drugs for SLE and Sjogren's, early RA and preclinical RA interventions, IgG4 disease, osteoporosis and the growth and application of artificial intelligence in medicine and rheumatology.

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Hong Kong study shows Very low dose prednisolone (<5 mg/d) doesn't confer excessive CV risk. 2 233 RA pts (105 826 Pt-years FUV; mean duration 8.7 yrs) - 7% developed MACE. MACE risk incr 7% per month in those taking ≥5 mg pred. https://t.co/lcehOgaqCQ https://t.co/AhWGnUuYcc

Links:

Dr. John Cush RheumNow ( View Tweet)
JAMA: Prophylaxis for Pneumocystis Pneumonia - indications and Rx - Immuncompromised and Immunodeficient - Pts on Hi Dose Steroids - ANCA–associated vasculitis https://t.co/2VhLxc4VNo https://t.co/cXuY4Manrk

Links:

Dr. John Cush RheumNow ( View Tweet)
RT @drdavidliew : Tapering pred in RA - this just rings true from everyday clinic life. Some patients just seem to hit a wall at PNL 2.5. Sometimes it’s GC withdrawal arthralgias/tertiary adrenal insufficiency, but often it’s genuine inflammation. I still wonder why? POS0050

Dr. John Cush RheumNow ( View Tweet)

#Top #EULAR learnings #SLE #recommendations 1 Limit #prednisone 2 use #biologics early if poor prognosis 3 #lupus #nephritis - treat early with #belimumab or #voclosporin and more Rx in #RCTs #gamechanger https://t.co/JHQHu91tud
Janet Pope Janetbirdope ( View Tweet)
Important from @cappelliMD @jhrheumatology irAE cohort on predictors of DMARD requirement in ICI-inflammatory arthritis, and persistent ICI-IA post-ICI cessation. The better we can predict these patients, the more we can get the right therapy early POS0951 #EULAR2023 @RheumNow https://t.co/YGTRl71505
David Liew drdavidliew ( View Tweet)
New 2023 @eular_org SLE recommendations Key changes, in response to evidence: - more caution re: steroids - biologics earlier - combo therapy (BEL or CNI/VCS) considered for lupus nephritis #EULAR2023 @RheumNow https://t.co/J3Lp8owRyT
David Liew drdavidliew ( View Tweet)
#SLE #EULAR recommendations What is new - use LESS #glucocorticoids, aim for none or 5 mg/d or less, use #biologics early if needed to prevent damage, #lupus #nephritis consider less pulse dose if using, voclosporin vs Belimumab ? it depends @RheumNow #EULAR2023 https://t.co/Ylnnl3pHOK
Janet Pope Janetbirdope ( View Tweet)
Meds in #lupus at #EULAR2023 recs - HCQ first line therapy. Target dose remains the same. Some discussion on monitoring levels if possible - MAIN CHANGE - Glucocorticoids to be minimized (only use for bridging). Nephrologists more so in favor of steroid free remission @RheumNow https://t.co/d8WnUOgrwq
Bella Mehta bella_mehta ( View Tweet)
We would think that targeted therapies would have reduced GC use in RA. Well, this is not really the case. Comaprison of GC use in 1999-2008 vs. 2009-2018 52% of patients remain on GC for>3Mo after initiation & 1/3 still continues after 2 years! @RheumNow #EULAR23 POS0309 https://t.co/dDkUJFlmEm
Aurelie Najm AurelieRheumo ( View Tweet)
#EULAR2023 #POS0222 Post-hoc Analyses of Phase 3 RCT in Rituximab-treated ANCA vasculitis patients only (65% of total) showed more patients met Remission rate & with lower GC Toxicity vs Pred Taper + RTX at 52 weeks, consistent with Trial Main Results @RheumNow https://t.co/BmiujbhQI9
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
Initial use of glucocorticoids GC as bridging treatment in RA resulted in increase use of GC later, fewer DMARD changes later, van Ouwerkek L, Abst#OP220 #EULAR2023 @RheumNow https://t.co/IjxgQTZ8SE
Dr. Antoni Chan synovialjoints ( View Tweet)
Treatment of IIM, MTX or AZA or IVIG are 1st line (with steroids). #EULAR2023 https://t.co/TDKWxgrST0
Dr. John Cush RheumNow ( View Tweet)
What do we do with PMR patients with subclinical GCA seen on ultrasound? Well, in these non-blinded cohorts the subclinical GCA pts got more pred. Was it warranted? Hard to say. If we’re going to look for it, let’s try and figure out what it means POS0712 #EULAR2023 @RheumNow https://t.co/KmCcE0Nsu9
David Liew drdavidliew ( View Tweet)
Rx of #lupus #SLE The most challenging seems to be longstanding & residual disease activity - damage accumulates over time - esp if #glucocorticoids are used. Consider only as bridging. How to treat #lupus #EULAR2023 Boumpas ⁦@RheumNow⁩ #ClinicalPearl ⁦@eular_org⁩ https://t.co/heBbcRAjxO
Janet Pope Janetbirdope ( View Tweet)
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