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Dr. Jack Cush reviews the news and journal reports from this past week on RheumNow.com. This week we delve into some odd associations, repeat drug warnings and the consequences of antirheumatic therapies.
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Next-generation DNA sequencing (NGS) techniques show the presence of bacterial DNA in surgical specimens of hip and knee arthritis, from patients undergoing first-time total joint arthroplasty, reports a study in The Journal of Bone & Joint Surgery.
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Peresolimab is a humanized IgG1 monoclonal antibody that acts as a programmed cell death protein 1 (PD-1) agonist (stimulator). The NEJM reports that PER met its efficacy primary endpont in treating patients with active rheumatoid arthritis (RA).
Dr. John Cush
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Avacopan in GPA
- non-inferior to prednisone for induction remission
- received FDA approval for treatment of severe active GPA in combo with standard therapy and steroids
- should be used in newly diagnosed active or relapsing disease
@rheumnow #RNL2023 https://t.co/My6M5MGBl1 https://t.co/0aPFUeE55Q
Dr. John Cush
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How to long for maintenance of GPA?
Continue for 24 months, then consider:
Relapse history? Organ damage? Toxicity? Patient wishes? Compliance? Family planning?
Dr. Langford @RheumNow #RNL2023 https://t.co/tFn2p5DfJV https://t.co/Uu4Fmans40
Dr. John Cush
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U.S. FDA Approves RINVOQ® (upadacitinib) as a Once-Daily Pill for Moderately to Severely Active Crohn's Disease in Adults based on induction studies, U-EXCEED, U-EXCEL,& U-ENDURE maintenance study. This is 7th FDA approval for RINVOQ https://t.co/FypYaTMJxU https://t.co/yilppBv6Ka
Dr. John Cush
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Dr. Carol Langford on GPA treatment
Duration of remission maintenance therapy?
- at least 2 years, after 2 years, maintenance appropriate in many cases
- consider RTX, and other cDMARDs (MTX, MMF, AZA)
@RheumNow #RNL2023 https://t.co/gAEo6SudES https://t.co/RGSzXy0vE5
Dr. John Cush
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Dr. Langford #RNL2023
When to use CYC over RTX for severe GPA induction?
- Severe disease with RTX intolerance
- Worsening disease despite RTX
- RGPN Cr > 4.0, mechanical ventilation? (these were excluded from RAVE trial)
@RheumNow https://t.co/AnSAnGP6Oa https://t.co/iHF6tiFvj2
Dr. John Cush
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Carol Langford #RNL2023
Use of CYC + RTX:
Not routine upfront, but may be needed for escalating disease
Limited data to support initial usage
Higher risk of hypogammaglobulinemia, infection, and death
@RheumNow https://t.co/DRLf1Zl5bN https://t.co/fSv5ciAklI
Dr. John Cush
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Carol Langford #RNL2023 @RheumNow
Rx options for GPA showed by targeted to patient's disease characteristics of severe vs non-severe disease
CYC not for non-severe due to toxicity
MTX, MMF not for severe disease https://t.co/jw3wq2k7gb https://t.co/y3ck6KuCDj
Dr. John Cush
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"Highest pre-test probability for GCA is actually:
1) Limb claudication
2) Jaw claudication
#RNL2023 @RheumNow https://t.co/Ed52fIcVaI" https://t.co/dA1FlCEU3i
Dr. John Cush
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GCA biopsy: When and How
Early is best, rec'd in first 2 weeks. Findings can be present at 8 weeks but be less prominent
@anisha_dua rec's unilateral imaging in most pts, especially w scalp tenderness on one side
>1 cm length
#RNL2023 @RheumNow https://t.co/Pn25Qt0WL4 https://t.co/5qROaTbD2w
Dr. John Cush
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Dr. Spiera's approach to PMR treatment
- prefers methylprednisolone
- rapid taper over 16 weeks
- consider GC sparing therapy (MTX, IL-6i)
@Rheumnow #RNL2023 https://t.co/LR9e0aXkeN https://t.co/qXUBkz5vfe
Dr. John Cush
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SAPHYR, presented at #ACR22, unpublished
Robert Spiera at #RNL2023
Phase 3 study for refractory PMR
Sustained remission of disease, less steroids usage, steroid toxicity, and improved PROs
@RheumNow https://t.co/oQJV7gUV3W https://t.co/S1LRBT55Qn
Dr. John Cush
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IL-6 for PMR
SPARE and SEMAPORE (Toci), SAPHYR (Sari)
2/2023: FDA approves sarilumab for PMR for inadequate response to corticosteroids or unable to taper off
Robert Spiera @RheumNow #RNL2023 https://t.co/VtzW01Ez7D https://t.co/P6oUQvmDXH
Dr. John Cush
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Swedish registry review of #MTX initiation in early #PsA vs #RA (n 3642each). 2 years after MTX start, 71% of PsA vs 76% of patients with RA remained on MTX & the majority (66%/60%) had not started another DMARD, or a biologic (77%/74%) https://t.co/nTJO04sn65 https://t.co/gLjKzj2c74
Dr. John Cush
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Evidence-Based Guidelines for EGPA
Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare form of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis, affecting between 10 and 14 cases per million globally.
https://t.co/VixECcPv4R https://t.co/XgEHRgDiPj
Dr. John Cush
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RELIEF Trial: Sublingual Cyclobenzaprine in Fibromyalgia
https://t.co/a6KUPcfmxM https://t.co/ToRJQVsZSu
Dr. John Cush
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RCT of 122 active plaque Psoriasis pts (38F, 55M) with low vitamin D (~15). Rx w/ either PBO or Vit D (100K IU, followed by 20K IU/wk x 4 mos). Vitamin D supplementation had no effect on psoriasis severity (but pts had mild PSO). https://t.co/JXtEBaop3c https://t.co/ScGtBUIrm0
Dr. John Cush
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Subanalysis of the tofacitinib ORAL Surveillance study shows the JAK "at-risk" population are patients Age ≥65 years or ever smoker who exhibited the excess adverse events (malignancies, MACE, MI, VTE, all-cause death) comparedd to TNFi (HRs 1.41–5.19) https://t.co/k78WsPR1Mv https://t.co/JmTDSctIa0
