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CARRA Consensus Treatment for Refractory Juvenile Dermatomyositis

d Jack Cush, MD

CARRA has developed consensus treatment plans for the use of biologic disease-modifying antirheumatic drugs (bDMARDs) in patients with refractory, moderately severe juvenile dermatomyositis. Juvenile dermatomyositis is the most common form of idiopathic, inflammatory myositis in childhood, with an estimated incidence of 3.2 per million children per year in the United States.

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Systematic review: RX of macrophage activation syndr (MAS), included 57 reports, 1148 MAS pts (889 sJIA, 137 SLE). Most effective was high-dose GCs, IL-1 (83%) & IFNγ (93%) inhibitors, especially in sJIA-MAS. Also Ciclosporin, etoposide, Ruxolitinib https://t.co/4EnMOnlcYl https://t.co/PQnAZLvVwq

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Dr. John Cush RheumNow ( View Tweet)
NEW VIEWPOINT—Arthritis complicating inflammatory bowel disease—the future is now https://t.co/FyojGF6Pvx @DrLauraCoates #GITwitter https://t.co/kMewGTDQTc

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The Lancet Rheumatology TheLancetRheum ( View Tweet)
NEW VIEWPOINT—Arthritis complicating inflammatory bowel disease—the future is now https://t.co/FyojGF6Pvx @DrLauraCoates #GITwitter https://t.co/kMewGTDQTc

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The Lancet Rheumatology TheLancetRheum ( View Tweet)
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Biologics Prevent AA amyloidosis progression to ESRD

d MedPage Today

One of the most serious complications of rheumat0logic and autoimmune diseases can be prevented with biologic drugs, a single-center chart review suggested, and some such products may be more effective than others.

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From LG cohort of myeloid neoplasms (861 MDS, 640 AML, 112 MDS/MPN, 89 MPN) autoimmune Rheum Dz (AIRD) found in 7.7% (lit suggests 8-30%), less in AML (4.7% vs 9.5% others). Common: RA (42%), CTD(18%), PMR (14%), vasculitis (12%), AxSpA (7%). https://t.co/ZXxOrZBunZ https://t.co/m5nIgrhohw

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Dr. John Cush RheumNow ( View Tweet)
174 Active RA pts not responding to MTX were started on TCZ. High GM-CSF (> 5 ng/ml and > 10 ng/ml) at baseline were the independent predictors of poor response to TCZ at Wk24. high GM-CSF had signif higher DAS28-ESR & cytokine levels at baseline https://t.co/AreLBseJDq https://t.co/OyIOkiUOT1

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Dr. John Cush RheumNow ( View Tweet)
IRIS-RA, a failed phase 2 study of Nipocalimab, an anti-FcRn mAb severe active RA not responding to TNFi. 53 seropos. RA pts did not achieve primary endpt of better DAS28-CRP at Wk 12 (but Nipo was numerically better & signif lowered RF, CCP, but not CRP) https://t.co/52HLsfpKLS https://t.co/eEifXA6MpP

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Dr. John Cush RheumNow ( View Tweet)
174 Active RA pts not responding to MTX were started on TCZ. High GM-CSF (> 5 ng/ml and > 10 ng/ml) at baseline were the independent predictors of poor response to TCZ at Wk24. high GM-CSF had signif higher DAS28-ESR & cytokine levels at baseline https://t.co/vy7czYwv1Z https://t.co/R2cYdNZ3V0

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Dr. John Cush RheumNow ( View Tweet)
FDA adverse event study of JAKi in #RA assoc w/ signif more VTE, ischemic heart Dz, & tachyarrhythmias. 75,407 on JAKi vs 303,278 on biologics (TNFi, RTX, TCZ); JAK had more VTE (ROR=2.11), CVA (ROR=1.25), IHD (1.23), arrhythmias (1.15 ), esp in 1st yr. https://t.co/IVsGwqpiJK https://t.co/4epOHdNHbO

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Dr. John Cush RheumNow ( View Tweet)
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Pollution and Autoimmunity (7.12.2024)

d Jack Cush, MD

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

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Efficacy of Biologics in Patients with Chronic KIdney Disease

d Jack Cush, MD

A retrospective cohort study of biological disease-modifying antirheumatic drugs (bDMARDs) persistence in rheumatoid arthritis (RA) patients with chronic kidney disease (CKD), shows the 3 year survicval to be under 50% but that all studied biologics were nearly equivalent

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FDA adverse event study of JAKi in #RA assoc w/ signif more VTE, ischemic heart Dz, & tachyarrhythmias. 75,407 on JAKi vs 303,278 on biologics (TNFi, RTX, TCZ); JAK had more VTE (ROR=2.11), CVA (ROR=1.25), IHD (1.23), arrhythmias (1.15 ), esp in 1st yr. https://t.co/BmNPk6zN6o https://t.co/fbzHQmPmH5

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Dr. John Cush RheumNow ( View Tweet)
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Cost-Effectiveness of Biosimilars vs Leflunomide

d Jack Cush, MD

An economic evaluation of 25 099 rheumatoid arthritis patients found that treatment with biosimilar disease-modifying antirheumatic drugs (DMARDs) were cost-effective compared with the conventional DMARD, leflunomide.

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ICYMI: 2023 EULAR Psoriatic Arthritis Recommendations

d Jack Cush, MD

EULAR has updated its treatment recommendations from the prior 2019 guidelines, since there have been several newly developed agents. The updated guidance includes 7 overarching principles and 11 recommendations regarding treatment strategy and pharmacological therapies.

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Abbvie announced upadacitinib (Rinvoq) is approved for use in polyarticular JIA and Psoriatic Arthritis (in children 2 years of age and older who have had an inadequate response or intolerance to 1 or more tumor necrosis factor (TNF) blockers) https://t.co/gvRzYpFl5i https://t.co/uSISWG3foy

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Dr. John Cush RheumNow ( View Tweet)
RT: @synovialjoints In a Swedish-Danish cohort study on patients with PsA, treatment with TNFi was associated with a small increased risk of NMSC and with non-significant numeric risk increases for both BCC and SCC compared with bDMARD naïve #EULAR2024 Abstract 0150

Dr. John Cush RheumNow ( View Tweet)

RT: @aurelierheumo TOLERA trial in RA RTX/ABA sequence versus RTX alone 10pts each group Primary outcome was ambitious: ACPA seroconversion No difference between ttmts (and also no seroconversion) No diff in disease activity No diff in ACPA change wt wk52 OP0069 #EULAR2024

Dr. John Cush RheumNow ( View Tweet)

TARGET compared triple DMARD to TNFi in 122 RA pts and association with CV risk. In a subanalysis they found no correlation between change in lipid measurements and change in vascular inflammation by FDG-PET. https://t.co/0HKogmdRGH https://t.co/cD7UVTgTQ3

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Dr. John Cush RheumNow ( View Tweet)
Swap or Cycle? Study OP0081 show after failure to a first TNFi in patients with axSpA, the drug retention rate was higher in the cycle strategy compared to the swap (IL-17i) strategy. No difference in the disease activity between cycle and swap strategy #EULAR2024

Dr. John Cush RheumNow ( View Tweet)

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