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The Annals of Internal Medicine reports that biannual rituximab infusions over 18 months was effective at maintaining remission in patients with antineutrophil cytoplasmic antibody–associated vasculitis (AAV).
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Dr. Jack Cush reviews the News and Journal Reports from the past week on RheumNow.com.
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Multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19 infection has both similarities and differences with Kawasaki disease, and requires distinct clinical management, according to draft guidance from the American College of Rheumatology (ACR).
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Flares in ANCA-associated vasculitis are difficult to predict, but serum calprotectin may help predict relapse and renal failure, according to data presented at the EULAR 2020 virtual meeting this week.
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Gianfresco et al have published the first peer-reviewed analysis of COVID-19 infected, rheumatic disease patients entered into the Rheumatology Global Alliance registry; showing that a) rheumatic disease patient can be infected with COVID-19, b) that DMARD and biologic use has no apparent effect on outcomes and c) steroid increase and TNF inhibitor decrease the odds of hospitalization.
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Dr. Jack Cush reviews the news and journal articles from the past week on RheumNow.com.
Dr. John Cush
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Study of 662 temporal artery Bx shows that when diagnosing #GCA, the TAB length should be at least 5 mm and should analyze at least 3 further sections at deeper levels for maximal yield. https://t.co/6zM9hBUsXy
Dr. John Cush
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Registry of COVID CNS complications reports 125 pts; 77 (62%) w/ Cerbrovascular event (57 ischemic CVA), 9 intracerebral hemorrhage, 1 CNS vasculitis. 39 w/ AMS, 9 encephalopathy & 7 encephalitis. 10 new-onset psychosis, 6 dementia, 4 affective Dz https://t.co/mXyTHIFBIE
Dr. John Cush
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Skin is often involved w/ ANCA+ vasculitis - 1184 AAV pt study shows skin involvement in 34% GPA; 28% MPA & 47% EGPA. Common are petechiae/purpura pruritus, urticaria, and maculopapular rash. AAV w/ skin Sxs have more systemic dz (GN, alveolar hemorrhage) https://t.co/egPdW2IEnu
Dr. John Cush
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Avacopan is as effective as steroids in ANCA Assoc Vasculitis – 330 pt RCT AAV Rx w/ RTX or CTX but randomized to p… https://t.co/mxm5NAjZtL
Dr. John Cush
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PRES - Posterior reversible encephalopathy syndrome. Review of US hosp records finds 3125 cases. Rheum Dz associations include ANCA+ vasculitis (OR 9.3), PsA (4.6), Scleroderma (6.6), SLE nephritis (7.5), SLE (2.4); also renal failure, pre-/eclampsia https://t.co/uLQxU3RNuD
Olga Petryna
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#EULAR2020 #op0143 a nationwide study concludes GCA pts at higher risk for sarcoma (HR 2.14), kidney cancer (1.6), hematological malignancies (HL2.42&non-HL1.66). Overall cancer HR 1.29. Time to diagnosis shorter in GCA (~48mo) vs controls (~58mo) @RheumNow https://t.co/obAlZw2gei
David Liew
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Here's the data for GCA (even though labelled PMR) using the same methods, both looking at first 1y.
Here's what gets me - it's obviously worse, but not that much worse... everyone's looking for steroid-sparing agents in GCA, but PMR's left behind?
OP0275 #EULAR2020 @RheumNow https://t.co/YWkNBVitGa
Janet Pope
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Whom with GCA should receive tocilizumab? What happens when it is stopped? Optimal dose for maintenance weekly or Q2 weekly? GiACTA gives only some answers. Need RWE #EULAR2020 @eular_org @RheumNow @CRASCRRheum @earlyarthritis #vasculitis https://t.co/aNvR14vfEV
Janet Pope
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What dose/frequency of rituximab do you use in maintenance ANCA #vasculitis? @RheumNow @eular_org @CRASCRRheum @earlyarthritis #EULAR2020
Dr. John Cush
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Avacopan is as effective as steroids in ANCA Assoc Vasculitis – 330 pt RCT AAV Rx w/ RTX or CTX but randomized to prednisone or avacopan (C5aR antagonist). Avacopan=prednisone remission rates same (72% vs 70%) wk 26 & wk 52 (66% vs 55%). #EULAR2020 #OP0011 https://t.co/WIXJCYkxSb
Mike Putman
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MAINRITSAN3 RCT, RTX v PLBO in AAV
28mo relapse free survival ⬇️ RTX (96% vs 74%, NNT~4), majr (100% vs 87%, NNT~8)
1. Selected grp (all pts from MAINRITSAN2)
2. All pts had GC q3mos - IRL benefit could be bigger?
Strong data for RTX >2yrs in AAV
PDF: https://t.co/Mbrq7bFHk0 https://t.co/auKJ3QPKr0
David Liew
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Enticing stuff. Avacopan wins on 52w remission, steroid toxicity/use, renal fx, with minimal toxicity.
Looks good to be a steroid replacement in AAV, with real benefit for patients. Exciting but cost will dictate if we get to use it (see: apremilast) OP0011 #EULAR2020 @RheumNow https://t.co/WTFk21D0KY
David Liew
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Big one from plenary, new option in ANCA-associated vasculitis:
avacopan (anti-C5a) vs prednisolone in patients receiving CYC/RTX: non-inf at 26w, superior at 52w in the phase III ADVOCATE trial with reduction in steroid toxicity
Merkel, Jayne et al OP0011 #EULAR2020 @RheumNow
David Liew
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Serum calprotectin as a biomarker in ANCA-associated vasculitis is enticing, and not just during induction:
during maintenance following remission, it might predict relapse and renal decline independently of disease characteristics
MAINRITSAN data OP0031 #EULAR2020 @RheumNow https://t.co/ItI0BPGrUX
