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RheumNow Podcast – High Science and Future Treatments (9.10.2021)
This week: high science that affect future treatments; breakthrough infections in our patients, and what's up with that; and soon your radiologist is going to be replaced by AI. This and more in our review of the news and journal articles from the past week.
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COVID Breakthrough Infections in Rheumatic Patients
Analysis of records from the Mass General Brigham healthcare system in the Boston area, shows that breakthrough infections (after receiving SARS-CoV-2 vaccines) in patients with systemic autoimmune rheumatic diseases (SARDs) are not uncommon, and may be severe or fatal.
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Baricitinib & Tofacitinib are effective in COVID-19 pts. These drugs are expensive; baricitinib is $44/tablet, but much lower for generics worldwide. 14 day course of TOFA would be >$1,400 in the US (but $600 in France, $25 in India) https://t.co/r2cn1H2z8i
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Dr. John Cush RheumNow ( View Tweet)
MMWR reports that during the COVID Delta variant era, Vaccination against COVID-19:
- Reduces risk of COVID-19 infection 5X
- Reduces risk of COVID-19 Hospitalization >10X
- Reduces risk of COVID-19 DEATH 10X
https://t.co/rMRY84xX5F
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Dr. John Cush RheumNow ( View Tweet)
Probenecid, an OAT3 inhibitor, has inhibitory effects on RNA viruses (influenza, RSV) & decreases ACE2 expression. May have utility in COVID-19 as it was shown to inhibit SARS-CoV-2 replication in animal models https://t.co/MClSjpqpSa
Dr. John Cush RheumNow ( View Tweet)
Differential Dx of immune-mediated necrotizing myopathies (IMNM) - HMGCR & Signal recognition particle Abs; checkpoint inhibitors, anti-Mi2 dermatomyositis, antisynthetase syndr. antimitochondrial Abs, GVHD, SARS-CoV-2 infection https://t.co/hhizx5gAet
Links:
Dr. John Cush RheumNow ( View Tweet)
Analysis of records from the Mass General Brigham healthcare system in the Boston area, shows that breakthrough infections (after receiving SARS-CoV-2 vaccines) in patients with SARDs are not uncommon, and may be severe or fatal.
https://t.co/Ri5QipR7YY https://t.co/TaTFTKfAzm
Links:
Dr. John Cush RheumNow ( View Tweet)
Confused by all the different types of #COVID 19 tests? They are broken down in an easy-to-use tool here: https://t.co/P5jHhnzFej #Antigen #Antibody #PCR @CreakyJoints @IFAiArthritis @US_Pain @IAFaccess @colorofcci @patientaccess @aimedalliance @patientsrising @AARDATweets
Lupus Association LADAOrg ( View Tweet)
3 of 4 COVID hospitalized in NJ are unvaccinated.
- 5.6 mill fully Vax; 2.7 mill unvaccinated,
- COVID hosp. rate of 4.33/100,000 fully vaccinated & 26.33/100,000 for unvaccinated.
- Unvaccinated are nearly 6 times more likely to be COVID hospitalized
https://t.co/nvDNODBlRW https://t.co/h3CcLXGLXG
Links:
Dr. John Cush RheumNow ( View Tweet)
Telephone survey of 278 Rheumatic Pts during COVID (July 2020) showed 22% reduced/interrupted treatments, only 11 (4%) stopped. Decisions made by half (49%). Stop Reasons: anxiety (48%), IV Rx access (45%), Rx unavailability (6.5%) https://t.co/XgJ1TJsHJG
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Dr. John Cush RheumNow ( View Tweet)
What's your prediction when the Pandemic will end and we can travel, vacation, hug & handshake?
Dr. John Cush RheumNow ( View Tweet)
JAMA: In women with spontaneous abortions, COVID-19 vaccine exposure was not increased compared with women without Spont Ab (ongoing pregnancy). COVID-19 vax given to 8.0% ongoing pregnancy vs 8.6% spont ab (adj OR 1.02) https://t.co/wEeaMR98Mf
Links:
Dr. John Cush RheumNow ( View Tweet)
MMWR: COVID-19–hospitalization rates in kids & adolescents rose 5-fold late June–mid-Aug 2021 (w/ rise of Delta variant). Hospitalization rates were 10 times higher among unvaccinated than fully vaccinated adolescents. https://t.co/Qt5lj3Ycxb
Links:
Dr. John Cush RheumNow ( View Tweet)
In case you missed it—
Booster Shots for Rheumatology Patients on
Immunosuppressive Medications
https://t.co/dIzrv3B12u https://t.co/nGIUNcqNTf
Links:
Dr. John Cush RheumNow ( View Tweet)
Our latest @MassGenBrigham rheumatology COVID collaboration with @zach_wallace_md #preprint to share quickly. 16 confirmed breakthrough infections in rheumatic patients since vaccine EUAs in US. 15 symptomatic, 6 hospitalized, 2 deaths https://t.co/atixfBcEbn
Jeffrey Sparks MD MMSc jeffsparks ( View Tweet)
Our @MassGenBrigham @zach_wallace_md rheum COVID paper on breakthrough infections is out now in ARD https://t.co/zOZqF0ecaG
Jeffrey Sparks MD MMSc jeffsparks ( View Tweet)
MMWR: COVID-19–hospitalization rates in kids & adolescents rose 5-fold late June–mid-Aug 2021 (w/ rise of Delta variant). Hospitalization rates were 10 times higher among unvaccinated than fully vaccinated adolescents. https://t.co/Qt5lj3Ycxb https://t.co/p2e0KoiAXr
Links:
Dr. John Cush RheumNow ( View Tweet)
Highly allergic can safely get the COVID Vax. Israeli study of 8102 pts w/ allergies recv Pfizer mRNA vax - 429 were highly allergic-->98% of the highly allergic had no allergic rxns, 1% mild allergic resp & 3 anaphylactic rxns Rx w/ EPI, none hospitalized https://t.co/ATYs5R5AQC https://t.co/owNEACH1pe
Links:
Dr. John Cush RheumNow ( View Tweet)
Not All Immunosuppression Alters Vaccine Immunogenicity
https://t.co/I9sShpMLBO https://t.co/oz9Qp1HM1e
Links:
Dr. John Cush RheumNow ( View Tweet)
PhIII trial of Baricitinib vs placebo in hospitalized COVID-19 pts (91% steroids, 13% remdesivir). While no diff (28 vs 30%) in primary outcome (O2, ventilation, death). BARI had signif better Mortality @28d (8 vs 13%) & 60d (10 vs 15%) w/ no incr in VTE https://t.co/AjoRgEKW8G
Links:
Dr. John Cush RheumNow ( View Tweet)
