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Scleroderma – Thick and Thin (6.30.2023)
Dr. Jack Cush reviews the news, journal articles and regulatory decisions from the past week from RheumNow.com. This week focuses on parodoxical psoriasis, scleroderma outcomes and subsets, and alopecia areata therapy.
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Dr. K. Frank Austen (1928-2023)
Rheumatology mourns the loss of a historic leader in the field, Dr. K. Frank Austen, who died at his home in Maine on June 23, 2023, at the age of 95.
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Scary Outcomes with Systemic Sclerosis Sine Scleroderma
The hallmark of systemic sclerosis is scleroderma, but less than 10% of SSc patients have sine scleroderma (ssSSc). A EUSTAR database review compared the manifestations and outcomes of ssSSC to limited cutaneous SSc and diffuse cutaneous SSc.
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Paradoxical PsO (PP) studied in 2867 RA & 5316 SpA pts. 136 (1.7%) had paradox. Rxn, median 12 mos post TNFi [pustular (60%) or palmoplantar (31%)]. 73% PP favorably switched to other TNFi 46% or non-TNFi 27%. RA PP took SSZ, HCQ, LEF; SpA PP more smokers https://t.co/w1EQEvHbeG https://t.co/aAwKxdNYk1
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Paradoxical Psoriasis in Kids Taking TNF Inhibitors
A multicenter cohort study reported a large cohort of pediatric patients receiving TNF inhibitor therapy complicated by psoriasis, regardless of treatment indication or the specific TNF inhibitor.
https://t.co/9WxkAt8NnS https://t.co/sGvb1eZWE0
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TitAIN Study: Secukinumab Efficacy in Giant Cell Arteritis
A phase 2 trial has demonstrated the efficacy of secukinumab, an anti-interleukin-17A monoclonal antibody, in patients with active giant cell arteritis (GCA).
https://t.co/rmYBXBV3RP https://t.co/q1CfhuGSj7
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Belimumab in adult inflamm myositis (IIM)? Small study 15 IIM pts recv ≥ 5 doses of belimumab or placebo; Treatment success (TIS ≥ 40) was more common with BEL (55% vs 33%) as was defined improvement (DOI: 33% vs 17%); not signif, but interesting! https://t.co/3xL0ylJbcs https://t.co/Oerf0yI4Jg
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FDA has approved a 2nd JAK inhibitor for Alopecia areata - Pfizers Ritlecitinib (Litfulo) is approved for Adults and Adolescents (>12 yrs) With Severe Alopecia Areata (based on ALLEGRO trial, pub in Lancet) https://t.co/Uods58glJG https://t.co/Uods58glJG https://t.co/syCqnG6sLg
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PRE-CLINICAL RA: What do you need to better manage pre-clinical (at-risk) Rheumatoid arthritis Patients? Rheumatologists vote here >>https://t.co/lt38vJMEIA
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RheumNow’s new Poster Hall features sponsor-generated clinical trial posters designed to educate and inform. Posters addressing vasculitis, AxSpa and nrAxSpa, and PMR now available.
https://t.co/38foNET3j4 https://t.co/8CjXwzyGab
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In pts seeking care for MSK pain cannot assume that improving pain/function will result in improved depression, but substantial improvements are required to effect anxiety. Study of 11 236 Ortho pts in JAMA https://t.co/5vvoPs31GU https://t.co/gEwZNW35xB
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Study of FDA review times for New Indication Approvals of Drugs and Biologics (2017 - 2019) finds FDA approved 107 drugs for 146 new indications [99 small molecules (68%) & 47 biologics (32%)]. Median regulatory review time was 6 mos (IQR, 6-10) https://t.co/3P6T4R4FCF https://t.co/avl65W3kvr
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UK MHRA reminder that NSAIDs are:
- contraindicated in the 3rd trimester of pregnancy (>28wks)
- >20 wks - assoc w/ increased risk of oligohydramnios & fetal renal dysfunction
MDs should avoid NSAIDs in pregnancy after wk 20 https://t.co/u3fTnuoF17 https://t.co/b2b5XThe1i
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Predictors of Cardiovascular Events in ANCA-Associated Vasculitis
A large, retrospective, multinational study of patients with ANCA-AAV shows they may be at risk for CVEs.
https://t.co/k9XPolEXKc https://t.co/0nxai3Eqe2
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Check SSc-ILD Patients on Nintedinib for Malnutrition
During nintedanib treatment for interstitial lung disease associated with SSc-ILD, clinicians prescribing the drug should be watchful for an unusual, indirect side effect, trial data suggested.
https://t.co/5Q3xCwLvPa https://t.co/mGD3DCYZR0
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RheumNow LIVE VOTE Survey:
What do you need to better manage pre-clinical (at-risk) Rheumatoid arthritis? Please vote here >>https://t.co/lt38vJMEIA
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Comprehensive, full-read overview of SLE treatment with Tyk2 vs JAK inhibitors https://t.co/KjLEYGfxAY https://t.co/btvoBQjboi
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2022 of fibromyalgia Year in review discusses possible causes (inflammation, gut dysbiosis, neuroinflammation), new Rx (kinin antagonists, neurostimulation, mind-body Rx; but more needed on ketamine, vitamin D, and hormonal therapy https://t.co/IovNztH1kP https://t.co/fEVjO6ZW67
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Mirikizumab, an anti-IL-23 MAb, shown to be effective in phase 2 trial in ulcerative colitis. 1281 Pts: mirikizumab > placebo group w/ remission at wk 12 (24% vs 13%, P<0.001) & after re-randomization & maintenance @wk 40l (50% vs 25%, P<0.001) https://t.co/9ZPsRCDhJc https://t.co/jrJvzAhyWY
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Metanalysis of JAK inhib in Alopecia Areata: 7 RCTs &1710 patients shows JAK inhibitors yielded > 50% hair regrowth (OR 5.28) or > 90% improvement (OR 8.15) vs PBO. Oral JAK inhibitors were better than topical (latter = PBO). https://t.co/J9kGh89aEi https://t.co/QbMY1m4NQe
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