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MTX + Pegloticase Combo FDA Approved
Horizon has announced that the U.S. Food and Drug Administration (FDA) has approved the expanded labeling of pegloticase (Krystexxa) injection to be co-administered with methotrexate (MTX), to improve response rates in patients with uncontrolled gout.
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#EULAR2022 POS0285
130K UK patients had incident gout bw 2004-2020
⭐️Only 29% started on ULT w/in 12 mos
⭐️Target urate level only 14% in 2004, only to 17% in 2020
Updated EULAR guidelines in 2016: No statistical difference in ULT Rx or target attainment
cc: @ericdeinmd https://t.co/nWUM90wRQr
Dr. John Cush RheumNow ( View Tweet)
N.Zealand adult registry of ~1million without CV disease, amongst whom 32K had gout. Having gout increased risk of CV events in women (adj HR 1.34;1.23-1.45) and men (1.18). CV risk in men was increased if not on ULT & not at target (~15%) https://t.co/AgHF45kY2c https://t.co/KzRvtMjS9p
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Dr. John Cush RheumNow ( View Tweet)
Study of 420 active #AS patients not responding to bDMARDs (TNFi, IL-17i) randomised to upadacitinib 15 mg/d or placebo. By wk14, UPA was superior by ASAS40 (45 vs 18%; p<0.0001)& other secondary endpoints (p<0.0001). https://t.co/nfOLlxgP5d https://t.co/fROMep8tbT
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Dr. John Cush RheumNow ( View Tweet)
JAMA full read on wt loss and type 2 diabetes.
- Diet, physical activity, & behavioral therapy
- high frequency counseling (≥16 sessions/6 mos)
- Wt medications effective as adjuncts to diet etc
- Rec surgery if BMI >40, unable to lose # or comorbidity
https://t.co/lgbNVPr8tz https://t.co/bzmdOvnxC7
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Dr. John Cush RheumNow ( View Tweet)
GLORIA trial presented by Martin Boxers. 2 yr RCT, 5mg Pred vs. PBO shows DAS28 benefit (-0.37 to -0.62) & -1.7 better X-ray (vs PBO) at 2yrs. BUT signif more harm (AE) RR 1.24; mostly infx. Is this a good trade off? Abst# OP0263 #EULAR2022 https://t.co/sjuOqDSjrM https://t.co/vniyDI77qE
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Dr. John Cush RheumNow ( View Tweet)
#AOSD cause is unknown, but matched case control study suggests signif link to Stressful life events (OR 2.56) & nonsignificant risk trending towards coal dust exposure (OR 3.0), allergy prior to onset (OR 2.67) & oral contraceptive use (OR 2.0) https://t.co/Saa4gEbzKS https://t.co/87RKgojmGZ
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Dr. John Cush RheumNow ( View Tweet)
Proposed investigations (findings) in the diagnosis of Stills disease:
- CRP, ESR, Ferritin (high)
- W/U for infection, cancer (negative)
- Serologies (negative)
- consider Imaging (CXR, CT, US, PET)
https://t.co/l3yqAx6PA0 https://t.co/Sg7okwKHaw
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Dr. John Cush RheumNow ( View Tweet)
Guidelines for MAS complicating Systemic JIA: Dx is based on:
- Fever in sJIA with ^ ferritin > 684, plus
- Any 2 of these: elevated PLTs, AST, Triglycerides or low Fibrinogen
https://t.co/aIEvxRYZca https://t.co/DYpLHxRCzI
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Dr. John Cush RheumNow ( View Tweet)
Cyclic GMP–AMP synthase (cGAS) engages stimulator of interferon genes (STING) to trigger inflammatory cytokines & type I interferons. cGAS–STING activation by genomic or mitochondrial self DNA implicated in autoinflammatory & autoimmune dz https://t.co/7CEFt9wLrl https://t.co/HpHhjJOATd
Dr. John Cush RheumNow ( View Tweet)
Five Mistakes When Diagnosing Still’s Disease
AOSD is likely to be the adult continuum of systemic-onset juvenile arthritis (sJIA) and hence, frequently affects young men and women below the age of 35 years.
https://t.co/C9kUOpFIlc https://t.co/82GIA7hSJl
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Dr. John Cush RheumNow ( View Tweet)
Tofacitinib had faster and larger impact on improvement of fatigue compared to placebo in treatment of ankylosing spondylitis pts.
Note 100% fatigue resolution roughly same vs. placebo
@RheumNow #EULAR2022 ABST#POS0305 cc: @doctorRBC : https://t.co/sodp75Nblw
Dr. John Cush RheumNow ( View Tweet)
Li et al. Orelabrutinib in SLE. 60 patient phase 2 RCT. Week 12 SRI(4) 50.0%/61.5%/64.3% in orelabrutinib groups vs 35.7% PBO. @RheumNow #EULAR2022 LB0005 https://t.co/wWJhlY5IYW
cc: @RichardPAConway : https://t.co/2IAURdfAOB
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Dr. John Cush RheumNow ( View Tweet)
#EULAR2022 Prof Schulze-Koops highlighted a mechanistic study that baricitinib therapy ex vivo suppressed autophagy, increased apoptosis, and reduced expression of adhesion molecules in #sjogren salivary glands. Next step should be randomised controlled trial cc: @Yuz6Yusof https://t.co/1tDBNzTuwQ
Dr. John Cush RheumNow ( View Tweet)
In vitro study shows Upadacitinib inhibits enthesis T cell derived TNFa and IL-17A, disrupting the prominent IL-23/IL-17/TNFa axis driving SpA.
@RheumNow #EULAR2022 ABST#POS0331
cc: @doctorRBC https://t.co/M8YYAOBVat
Dr. John Cush RheumNow ( View Tweet)
#OP0004 #EULAR2022 In line with EULAR President’s preech to go Digital, Prof Mosca highlighted a study which showed assessment of joints in RA could be done by taking photos and analysed their dorsal skin folds using convolutional neural network
cc: @Yuz6Yusof : https://t.co/mn48vXtGad
Dr. John Cush RheumNow ( View Tweet)
Bimekizumab: IL-17A and F inhibitor for tx of PsA - BE OPTIMAL trial reached primary endpoint: ACR50 44% vs. placebo
Efficacy as early as 2 weeks
No MACE, uveitis, IBD, deaths
@RheumNow #EULAR2022 ABST#LB0001 cc:@doctorRBC : https://t.co/wgeBsfdQcL
Dr. John Cush RheumNow ( View Tweet)
Prof Hoi @alberta_hoi Anti-Sm in SLE. Present in 17%. Assoc severe disease activity, "classic" SLE manifestations, specific serologic and proteomic profile. Argues for Sm+ SLE being a specific subset (or even a "different" disease?)
#EULAR2022 POS0774. cc: @RichardPAConway https://t.co/cwp6q4kouz
Dr. John Cush RheumNow ( View Tweet)
#Bestinclass Recurrent #PMR RCT of #sarilumab v placebo. Nearly doubles sustained remission but maybe attenuating effect - flare difference over time? N=118. 🤷♀️ Dunno who I would use it in yet. LB0006 @RheumNow @eular_org #EULAR2022
@Janetbirdope
Dr. John Cush RheumNow ( View Tweet)
SELECT-AXIS 1 trial of upadacitinib in active #AS with an inadequate resp to prior biologic - pivotal phase 2/3 RCT of 420 AS pts (Dz dur 7.7 yrs; 83% B27+) showed better ASAS40 at wk 14 w/ UPA vs PBO (45% vs 18%; P<0.0001) #EULAR2022 POS0306 https://t.co/JmreAOqnqh https://t.co/pTFeAzWUYU
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Dr. John Cush RheumNow ( View Tweet)