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World Changers (3.14.2025)

Jack Cush, MD

Dr Jack Cush and his podcast friends are out to change the world. Here is his weekly review of the news and journal reports from the past week on RheumNow.

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Channeling Bias and Cancer Risk with Biologic or Targeted Synthetic DMARDs

Jack Cush, MD

A retrospective US administrative claims cohort study of RA patients on tumor necrosis factor inhibitors (TNFis), non-TNFi biologics, or Janus kinase inhibitors (JAKis) found a statistically significantly higher risk of incident cancer in patients receiving rituximab, abatacept, or JAKis (compared with TNFis).

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Glucocorticoid Toxicity Index

Jack Cush, MD

Dr. John Stone has led the effort to develop the GTI - glucocorticoid toxicity index. In this review article he acknowledges the need and benefit of steroids, but details a novel means to identify and limit the untoward effects of glucorticoids (GC).

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2024 Rheumatology Year in Review

Jack Cush, MD

2024 was a year of surprising new growth in technology, with the expansion of new therapeutic options for many patients and clinicians.  While these many advances offer new hope, they are countered by disappointments and gapping unmet needs in rheumatology. Below is my top 10 list (in no particular order) of 2024 developments and desires that may change rheumatologic practices.

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Cardiovascular and Fracture Risk with Denosumab Versus Bisphosphonates in Dialysis Patients

Jack Cush, MD

Annals of Internal Medicine has published a  Japanese administrative claims database study showing that, compared with oral bisphosphonates (BIS), denosumab (DEN) lowered fracture risk by 45%, but increased the risk for major adverse cardia

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Are Combination Biologics Safe?

Jack Cush, MD

Although package inserts commonly warn against combining the use of biologic or targeted therapies, there is growing interest in such combination therapy for patients with problematic immune-mediated inflammatory diseases (IMID).

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Long-Term Use of NSAIDs Linked to Lower Dementia Risk

MedPage Today

Long-term use of non-steroidal anti-inflammatory drugs (NSAIDs) was tied to a decreased risk of dementia, data from the prospective Rotterdam Study showed.

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Sobi announced it has submitted to FDA a supplemental (sBLA) for Gamifant (emapalumab-Izsg) for use in adult & kids w/ hemophagocytic lymphohistiocytosis (HLH)/macrophage activation syndrome (MAS) in Still’s disease with an inadequate response glucocorticoids, or with recurrent… https://t.co/PLpcD5jzxH https://t.co/0LUe9bXaYS
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With GLP-1 agonists, is there a risk of aspiration during gen. anesthesia. Most advise against elective surgery/anesthesia unless the GLP-1 is held for 1-2 weeks. Based on MOA of delayed gastric emptying - 7/8 studies show Incr residual gastric contents in GLP-1, but none… https://t.co/U690OmeqJm https://t.co/Q6kyv9fyVJ
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A Veterans study of 27,540 #RA pts shows the risk of multiple myeloma (MM) did not differ b/tsDMARD & csDMARD users. 30% took b/tsDMARD during follow-up (192,000 PYs). MM incidence rate: b/tsDMARD-naïve 0.37/1000PYs vs csDMARDs 0.42/1000PYs (HR 1.32; 0.78, 2.26)… https://t.co/Xp4v4eIQnd https://t.co/5MVdz5UQSb
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Long-Term Use of NSAIDs Linked to Lower Dementia Risk https://t.co/nlo2BodhLG https://t.co/TiE34zyvts

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Are Combination Biologics Safe? Real-life data from a French observational study suggests the overall risk of severe adverse events (SAE) with combotherapy does not seem to be increased (vs monotherapy), but certain combinations warrant caution. https://t.co/IEIi6kQI4b https://t.co/KVSbqeMbyA

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Hydroxychloro-King (3.7.2025) Dr. Jack Cush reviews the news, journal reports and regulatory actions from the past week on RheumNow. https://t.co/83ZAyrrgg3 https://t.co/63cIdP559y

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Dr. John Cush RheumNow ( View Tweet)
The European Commission (EC) has approved Celltrion’s Avtozma (CT-P47), a biosimilar referencing Roche’s RoActemra (tocilizumab). https://t.co/ukMDwtgUhw https://t.co/htDVWKbu3n

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Metanalysis of cancer risk w/ abatacept vs placebo or TNFi in #RA. (18 RCTs, 10 LTE, 15 535 PYs ABA exposure) show no signif increase in malignancy for ABA vs PBO (IRR 0.58) or TNFi (IRR 0.72). Observational data ABA > other b/tsDMARDs (IRR 1.21; 1.15–1.28), but not csDMARDs… https://t.co/2aBfwyKv0e https://t.co/zUmaHZN3mR
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DANBIO registry study - 21 982 Rx Starts, 96 475 PYs & 1423 cancers identified. Overall cancer risk w/in tocilizumab/sarilumab, abatacept or rituximab were not signif increased (HRs ranged from 0.7 to 1.1) compared with TNFi & with bDMARD-naïve real world RA pts… https://t.co/fPLFlWoQsw https://t.co/4KlGnjfNKm
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BMS announced new data from Phase 3 POETYK PsA-2 trial - Sotyktu (deucravacitinib)vs apremilast vs PBO in PsA w/ higher ACR20 vs PBO at Week 16 (54% vs 39%). AEs led to discontinuation in 1.3% (PBO), 2.2% (Deuc) and 10.5% (apremilast). https://t.co/NAa2JigkZN https://t.co/mvaQXfjShd

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Intraarticular Steroids in OA Lowers Need for Pain Meds Is it possible that intra-articular corticosteroid injections for osteoarthritis might affect the use of opioids? https://t.co/qkTN7CpuMZ https://t.co/npuT88Sj2m

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Early Hydroxychloroquine Slows Cutaneous Lupus Progression A prospective study of patients with limited cutaneous lupus erythematosus (CLE) shows that early introduction of hydroxychloroquine (HCQ) may prevent progression to systemic lupus erythematosus (SLE).… https://t.co/evsvf2GQiL https://t.co/J0Zl35FEHz
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Bimekizumab efficacy and safety in patients with psoriatic arthritis who had skin and nail psoriasis at baseline: Up to 2-year results from two phase 3 studies https://t.co/QGdQtp3Mbe

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