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Late Should Not Be Less (11.3.2023)
Dr. Jack Cush reviews the news, journal reports and regulatory approvals from the past week on RheumNow.com.
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H. Zoster Subunit Vaccine Efficacy with JAK Inhibitor Therapy
JAK inhibitors are known to increase the risk of herpes zoster infections between between 3-5 fold. Two recent reports suggest variable efficacy when JAK inhibitor (JAKi) treated patients are vaccinated with the recombinant herpes zoster subunit vaccine (RZV).
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Oral Surveillance Study Alters Practice at VA
Safety risks found in a postmarketing trial with the Janus-associated kinase (JAK) inhibitor tofacitinib (Xeljanz) appear to have influenced prescribing patterns across the class for rheumatoid arthritis (RA) patients in the Veterans Affairs (VA) health system, researchers found.
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Cardiovascular and Venous Thromboembolic Risk With JAK Inhibitor Treatment of Skin Disorders
A JAMA systematic review and meta-analysis has showed the use of JAK inhibitors (JAKi) in immune-mediated inflammatory skin diseases was not associated with increased risk of all-cause mortality, major adverse cardiovascular events (MACE), or venous thromboembolism (VTE) (compared to the placebo
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Optimal Management of DQT
The treatment of DQT was examined by systematic review in JAMA, suggesting that local corticosteroid injection + a thumb spica immobilization was associated w/significant pain-relieving and functional benefits.
https://t.co/1437g9ylZy https://t.co/TTlF28oa1S
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Study of LATE-onset RA (>65y), shows DMARD initiation is low in LORA; despite current clinical practice guidelines recommending early aggressive Rx. Among 3,373 LORA pts (age77 yrs), only 29% initiated on a DMARD (28.9%). https://t.co/bWHaiiSMVl https://t.co/NmrDeG8UPW
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Fast track clinics -the future of #PMR care?
As the month dedicated to PMR draws to a close, we begin to look to the future, and what the ideal management of PMR looks like.
https://t.co/F4oRPnKWhe https://t.co/1yoUNaQqW5
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Study of TNFi tapering in 108 axSpA patients in remission. Gradual tapering over 2 yrs resulted in flares in 99% (108).
- 27% flared at 2/3 dose
- 20% at 1/2 dose
- 27% at 1/3 dose
- 25% w/ discontinuation
WHY WOULD YOU DO THIS? I DONT! https://t.co/mIJKaK3LK5 https://t.co/SMGJVfepTl
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256 Early RA pt cohort followed 10yrs showed SDAI sustained remission(n 48) had less 10 yr Xray progression (mTSS 4.06), vs sustained LDA (14.6) or MDA/HDA (21.04). Sustained remission pts were younger, lower HAQ & mTSS scores; less need for GC & bDMARDs https://t.co/92L7RTCx82 https://t.co/4uZBydcfRM
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Steroid (GC) use is increasing - Claims data from (US, Taiwan, Denmark; n=54,630,437; 2009-2018), GC use increased from 6.4 to 7.7% USA, 16.6 to 18.7% Taiwan, & 1.7 to 2.9% Denmark. Most Rx by PCP to healthy adults; 20-25% Rx for URI. https://t.co/GkQR0hcys1 https://t.co/5fpBv2Kyo8
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National Health Information Survey 2022 shows that 41.5% of US adults used the Internet to communicate with a doctor’s office; highest in metropolitan areas and decreasing in urban areas https://t.co/utU2YT7mt5 https://t.co/Y4U8ohy71s
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BMJ State of the Art (full read) review of ADVANCES in LUPUS THERAPY (Morand EF, et al).
- Recent SLE RCTs
- Pathogenesis, genetics, epigenetics
- Phenotypes
- Emerging treatments
- Guidelines on Rx
https://t.co/OVJRVA8hoz https://t.co/6Srmo5vNjF
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Analysis of German RABBIT registry did not show more MACE events in pts w/ JAK inhibitors compared to other DMARDs. 154 MACE w/ 14203 Rx episodes (21218 Pt-Yrs). IRs were 0.68 JAKi, 0.62 TNFi, 0.76 bdMARDs and 0.95 csDMARDs; higher in CV risk pts https://t.co/2UZh4zQFEM https://t.co/VRX2Z8YBrC
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FDA has approved another ustekinumab biosimilar (Wezlana) as being interchangeable for use in adults with plaque psoriasis, psoriatic arthritis, Crohn’s disease and ulcerative colitis. https://t.co/zbQKjmKgZh https://t.co/UuTDRgCBIV
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FDA has approved secukinumab (Cosentyx) for use in adults w/ moderate to severe hidradenitis suppurativa. Recommended dose is 300 mg SC @ wk 0, 1, 2, 3 and 4 and then every 4 weeks thereafter. https://t.co/Pi6RbDbroG https://t.co/AWhbVj2QGa
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FDA has approved Abatacept to Treat Juvenile Psoriatic Arthritis (JPsA) in patients aged 2 to 17 years. (JPsA) in patients aged 2 to 17 years. This expands the current indications for ABA use in RA, poly JIA, PsA, and GVHD. https://t.co/eAc8Dsyc3b https://t.co/uHJqhEvuPG
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RheumNow Live registration is NOW OPEN! Early bird pricing through 11/30/2023. Register today!
https://t.co/1SjBiM7Daj https://t.co/w2cFcj85r5
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Choosing steroid sparing therapies in #PMR
We have no evidence-based alternative treatment to glucocorticoids in PMR. Few disease-modifying anti-rheumatic drugs, such as methotrexate and leflunomide, are used in daily clinical practice in PMR.
https://t.co/zvfAwc7t1z https://t.co/pAJFHF6hOn
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Blinkers and the Unseen Information Gap in #PMR
https://t.co/uZ9qCPmRw9 https://t.co/lrXRdVGNk2
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#PMR Mythbusters: PMR Gets 100% Better Within 72 hours
https://t.co/lezwD0J8pL https://t.co/QluGHHnH3X
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