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Biologics for JIA? Not So Fast, Say Insurers

MedPage Today

It's not a simple matter to prescribe tumor necrosis factor (TNF) inhibitors for patients with juvenile idiopathic arthritis (JIA), at least those with insurance, a single-center study found.

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TNR - Controversies in PsA

Jack Cush, MD

Held on April 19, 2022, Tuesday Night Rheumatology: Controversies in PsA, featured a lively and informative panel discussion, moderated by Dr. Jack Cush.



The PsA Expert panelists included:

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Male vs. Female Responders (4.15.2022)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal Reports from the past week on RheumNow.com - including fellowship COVID-19 concerns, the limits of T2T in gout and the real odds of RA remission with your first biologic. 

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Is Alzheimer's Risk Lower With TNF Inhibitors?

MedPage Today

Tumor necrosis factor (TNF) inhibitors for rheumatoid arthritis were linked with a lower risk of Alzheimer's disease and related dementia, but only in people with cardiovascular disease, data from the DREAM (Drug Repurposing for Effective Alzheimer's Medicines) study showed.

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Psoriasis Severe legs sara

Differences in Biologic Persistence in Psoriasis and Psoriatic Arthritis

Jack Cush, MD

Administrative claims analysis of biologic use in psoriasis (PsO) and psoriatic arthritis (PsA) in French health insurance databases shows that despite widespread biologic use, overall drug persistence (beyond 3 years) was low for PsO and PsA biologics.

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Lupus Worries (3-25-22)

Jack Cush, MD

Dr. Jack Cush Reviews the news and journal reports from the past week in RheumNow.com.

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Stable Low Risk of Acute Coronary Syndrome in RA

Jack Cush, MD

A Nordic multinational collaborative study examined the risk of acute coronary syndrome (ACS) in rheumatoid arthritis and found a less than 2 fold increased risk of ACS patients initiating biologic disease-modifying antirheumatic drugs (bDMARDs) with little risk variation with short-ter

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Adalimumab Addition vs. Methotrexate Escalation in Psoriatic Arthritis

Jack Cush, MD

An interesting study in Lancet Rheumatology shows that psoriatic arthritis patients not responding to methotrexate alone can respond after adding or escalating adalimumab (ADA) on top of methotrexate (MTX) to reach minimal disease activity (MDA) response. 

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Can IL-22 differentiate between IL-17 & TNF inhibitor #PSA responders? Pilot study 2 cohorts 81 PSA pts showed both biologics worked but somewhat better response in IL-17i Pts w/ low IL- & TNFi responses w/ high IL-22 levels. https://t.co/txyNl2OwTP

Links:

Dr. John Cush RheumNow ( View Tweet)

NPF COVID-19 report from AAD mtg shows #PSA pts on systemic Rx were not at risk of hospitalization or severe COVID-1 based on US claims data. Also TNFi, IL-17, IL-23 Rx not affect on Vax Ab responses; less hosp (36%) w/ TNFi https://t.co/ekvu0mMvrn https://t.co/Qogm1Vx5hF

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Dr. John Cush RheumNow ( View Tweet)
2020 Pt preferences survey- 137 #PsA pts most took TNFi (30%), IL-17i (20%), MTX (10%). From 2018 to 2020 a signif incr in IL-17i & PDE4 inhib. Pts want Rx for damage (80%), ADL (71%), & pain (70%) https://t.co/2dyIuQubh5 https://t.co/sFbtRj0Lbv

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Dr. John Cush RheumNow ( View Tweet)
Useful TST (PPD)/IGRA interpreter website for TB testing. A 31 yoM Texan w/ +IGRA only (true pos) has risk of active TB & INH hepatitis 0.1% & 0.4%. But if this was 60 yoF from Iraq on TNFi & pred the same risks are 20% & 2.3% https://t.co/M18cHuLrXu https://t.co/zIoFY4abXN

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Dr. John Cush RheumNow ( View Tweet)
Czech registry compared drug survival csDMARDs vs TNFi monotherapy. Drug retention higher w/ combo (47 vs 23 mos; p < 0.001) than TNFi monotherapy. 5 yr survival was better 45% vs 26%; Combo w/ MTX > other csDMARDs (p = 0.003). https://t.co/pjbXwEQ53K https://t.co/nZj64Wk3Pt

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Dr. John Cush RheumNow ( View Tweet)
Study of 1899 ankylosing spondylitis pts(10 RCTs) shows TNFi resp can be predicted - 34% had major resp vs 34% w/ no resp @ wk12. A major resp increased w/ higher CRP, Pt Global & BASDAI-Q2 score & decr w/ higher BMI & BASFI https://t.co/DrT7EVcZi0 https://t.co/CcFicTM0Mo

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Dr. John Cush RheumNow ( View Tweet)
Ask Cush Anything! Have a rheumatology question or case for Dr. Cush? Submit it here and we may feature it on an upcoming podcast. https://t.co/KgPIeScthr https://t.co/nk4re9mlcH

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Dr. John Cush RheumNow ( View Tweet)
@Janetbirdope on drug cycling in #RA. What’s beyond TNFi failure? No golden rule, but: 👉🏻 switching to non-TNF can be superior than staying with the TNFi class 👉🏻 response to other bDMARs maybe blunted in non-TNFi naive 👉🏻 JAKi can be a good choice for some @RheumNow #RNL2022 https://t.co/25MiiFh2CK
Elena MyasoedovaMD MyasoedovaElena ( View Tweet)
@Janetbirdope on drug cycling vs. switching in RA Interesting data showing switching to non-TNFi superior to cycling in TNFi-incomplete responders Most bDMARDs and JAKi have blunted response post-TNFi @RheumNow #RNL2022 https://t.co/Lb3wvHZdzN
Robert B Chao, MD doctorRBC ( View Tweet)
Impact of fibromyalgia on Anti-TNF treatment response!! Philip Mease @RheumNow #Rnl2022 https://t.co/BYdZA3uu94
Nouf Al hemmadi NoufAhmedAlham2 ( View Tweet)
TNFi and pregnancy No association w/ congenital anomalies/infant infection Discontinuation of TNFi before wk 24, increases risk of disease flare Biologic lvls low in breast milk Does not affect vaccine response Live rotavirus vaccine did not cause infection @RheumNow #RNL2022 https://t.co/ZNdjf5qNDb
Robert B Chao, MD doctorRBC ( View Tweet)
Synergetic effect of IL17 and TNF in PSA. Bruce Kirkham @RheumNow #Rnl2022 https://t.co/acfqiluJWR
Nouf Al hemmadi NoufAhmedAlham2 ( View Tweet)
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