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Upside Down with Tocilizumab in COVID-19

Jack Cush, MD

Several recent reports offer conflicting views on the potential benefits and adverse outcomes of IL-6 inhibition with tocilizumab (TCZ) therapy in patients with severe COVID-19 infection.

An Italian study grabbed the headlines yesterday with a press release stating TCZ did not improve respiratory symptoms, ICU admissions or mortality rates when given to 126 COVID patients with early disease. The study, supported by the Italian Medicines Agency (Aifa), stopped enrollment (about 1/3 of projections) after an interim analysis found insufficient evidence that TCZ would be effective.  This report has not been published or undergone critical review.

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RheumNow Podcast – Enough Already with Weaning (6.19.20)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal reports from the past week on RheumNow.com.

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Dexamethasone Reduces Mortality in Severe COVID

Jack Cush, MD

Preliminary results released today shows dexamethasone (DEX), given to hospitalized, severly ill, COVID-19 patients, is capable of reducing mortality rates by one-third, with researchers calling this a “major breakthrough” in coronavirus management.

The results stem from a UK trial, called the RECOVERY trial, launched in March 2020, compared outcomes of around 2100 patients who were randomly assigned to DEX treatment compared with 4,300 patients not on DEX. 

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EULAR 2020 Roundup

Virtual EULAR 2020 Round Up

Jack Cush, MD

In this week's podcast, Drs. Artie Kavanaugh and Jack Cush present highlights from the virtual EULAR2020 meeting held June 3-6, 2020. Featured reports include the SELECT-CHOICE study, the EXCEED trial, Avacopan in AAV, BeST mortality outcomes, BLISS-LN study, biosimilars and tofa in systemic sclerosis.

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EULAR and ACR COVID19 Guidelines: Similarities Provide Reassurance

Rachel Tate, DO

In difficult times, it's reassuring to reflect on the similarities that bring us together. In the case of the EULAR and ACR COVID19 guidelines as discussed at #EULAR2020 by Drs.

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Early COVID 1255 patients In Wuhan, China - median age 64 yrs; 53 male: 63% w/ chronic comorbidities. There were 17 autoimmune pts w/ COVID () - median age 64; 83% female; only 1 admitted to ICU and one died. 10 stopped DMARDS & 5 their Dz worsened https://t.co/1KgU9tYUqV

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Dr. John Cush RheumNow ( View Tweet)

The 5 states with the highest slope of case increasing, per million population, June 20th 1. Arizona (way out in front) 2. South Carolina 3. Florida 4. Texas 5. Oklahoma (pre-rally) https://t.co/M1PsBgmhJb
Eric Topol EricTopol ( View Tweet)
RheumNow Podcast is Up! New FDA approvals for secuminumab, canakinumab, risk of GI perforations, tocilizumab in COVID, Weaning DMARDs/Biologics and Blacks with AS. Watch here>> https://t.co/2fTQPJ5iSr Listen to the podcast on Soundcloud>> https://t.co/uPklKQEauE

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Dr. John Cush RheumNow ( View Tweet)

MMWR reports that hospitalizations were 6 times higher and deaths were 12 times higher when the COVID patient presented with comorbidities - the most common being cardiovascular disease (32%), diabetes (30%), and chronic lung disease (18%) https://t.co/JPynBcJYfR https://t.co/kiBEIV38Sg

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Dr. John Cush RheumNow ( View Tweet)
FDA has revoked it's emergency use authorization for hydroxychloroquine in COVID-19. "CQ and HCQ are unlikely to be effective in treating COVID-19 for the authorized uses .... (and)..in light of ongoing serious cardiac adverse events and other serious AE" https://t.co/TrzJQVzsv7

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Dr. John Cush RheumNow ( View Tweet)

It is also important that I recognise the critical role of the @ACRheum and @eular_org to @rheum_covid as well as many other supporting organisations. Their contributions have been instrumental. We now also have corporate sponsors. Thank you all https://t.co/T15q5OwTLK

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Dr Philip Robinson philipcrobinson ( View Tweet)

My brush with COVID- heart-breaking and inspirational. A story about Larry and Jessica. https://t.co/zZTmwcmRe0

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Dr. John Cush RheumNow ( View Tweet)

The first randomized clinical trial of convalescent plasma in #COVID19, reported by Li et al in JAMA suggests that high titer antibody against #SARSCoV2 may have antiviral efficacy https://t.co/6YIib2GXGX

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JAMA JAMA_current ( View Tweet)

I'm really humbled by the amazing ongoing effort to collect cases for @rheum_covid. So many ppl are working tirelessly to help including the steering committee, patients & the pt board, contrib. rheums & the CASC. Please continue to contribute cases. Thank you 🙏 https://t.co/cK4FZXquMp
Dr Philip Robinson philipcrobinson ( View Tweet)
Another Italian COVID-19 dermatology report: 1,193 skin psoriasis patients on TNFi, IL17,IL23,IL12/23 & apremilast: 22 patients infected, of those 5 hospitalised, none died https://t.co/HpN908qsHd

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Dr Philip Robinson philipcrobinson ( View Tweet)

There have been 1,831,821 cases & 106,181 deaths from #COVID19, a 5.8% conf case-fatality rate. To put it another way, 1 out of 17 Americans w/ confirmed #SARSCoV2 has died. It is now the #1 cause of death in the US. The message is getting lost: this #pandemic is very serious.

Tatiana Prowell, MD tmprowell ( View Tweet)

Increased severity of #COVID19 seen in bald men related to the androgens. @rheumnow Androgenetic Alopecia Present in the Majority of Hospitalized COVID-19 Patients – the “Gabrin sign” https://t.co/T9pHuBypHp

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k dao KDAO2011 ( View Tweet)

#EULAR2020 Dr. Kimme Hyrich reviews the EULAR #COVID19 Registry "Most individuals with rheumatic diseases receiving immunosuppressive therapies recover from COVID19" @rheumnow https://t.co/EdVLUMyHhF
k dao KDAO2011 ( View Tweet)
#EULAR2020 panel on #COVID19 spec. situatns: 1. German regtry: very few preg rheum pts w/CV19; cases mild. 2. No info how CV19 affects APS 3. Very few ped rheum cases of CV19- cases mild; outcomes sim to gen peds pop 4. Most rheum pts w/CV19 good prognosis @rheumnow https://t.co/LQVdzJKCgu
k dao KDAO2011 ( View Tweet)
#EULAR2020 press conference report: Global Rheum Alliance for COVID19 and Eular registries provide reassurance to rheums and pts regarding immunosuppression and COVID19. The compiled data from over 600 pts in 40 countries. @RheumNow https://t.co/qMwGJTL041

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Dr. Rachel Tate uptoTate ( View Tweet)

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