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Best of 2021: FDA Puts Boxed Warnings on JAK Inhibitors

d Jack Cush, MD

Based on the safety review of tofacitinib in Pfizer's Oral Surveillance (1133) study, the FDA has added serious boxed warnings to all three marketed JAK inhibitors (for inflammatory diseases) and formalized the recommendation that patients should be started on a TNF inhibitor (TNFi) before trying a JAK inhibitor. These recommendations apply to tofacitinib, baricitinib and upadacitinib.

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Best of 2021: Comparison of Three Coronavirus Vaccines

d Jack Cush, MD

On Feb. 27, the Food and Drug Administration announced it has issued an emergency use authorization for Johnson & Johnson’s one-dose Covid vaccine, making it the third COVID-19 vaccine to be commercially available.  We've compiled a comparison table and some key information relevant to your delivering patient guidance henceforth. 

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Best of 2021: Tofacitinib Safety Concerns

d Jack Cush, MD

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

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Best of 2021: Abbvie has released data from KEEPsAKE-1 and KEEPsAKE-2 studies (1407 pts) showing Risankizumab (IL--23 inhibitor) is effective in Psoriatic arthritis; RIS Rx pts achieved ACR20 of 57% and 51% at week 24 (vs PBO 34% and 27%; p<0.001) https://t.co/0C07aTlEQY

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Best of 2021: Vagal Nerve Stimulation in Rheumatoid Arthritis Lancet Rheumatology has reported the results of a proof of concept trial, wherein vagal nerve stimulation was shown to ameliorate rheumatoid arthritis (RA) disease activity. https://t.co/cXCVN85HTG https://t.co/BePEkIn9l8

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Best of 2021: Alveolar Hemorrhage and Mortality in Lupus Metanalysis of patients with DA), show this to be a rare and life-threatening complication of SLE, that is more apt to affect older, severe lupus patients with active infection. https://t.co/QvXiWKLTlm https://t.co/IFAS1loBId

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Best of 2021: Avacopan - Is it Really a Win for ANCA-Associated Vasculitis? The NEJM has reported the results of a study showing that avacopan, a C5a receptor inhibitor, is as effective as steroids at treating patients with ANCA-AAV. https://t.co/cm9PX66zE7 https://t.co/e7S5C6eugK

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Best of 2021: Very high levels of IL-18 IL-18 (> 10 000 pg/ml) is associated with Macrophage Activation syndrome (with systemic JIA) as well as primary and secondary Hemophagocytic lymphohistiocytosis (HLH) https://t.co/FQPAHZTi4M https://t.co/UkNh2no123

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Danish Cohort study of 5310 cutaneous LE or SLE pts between 1995-2014 (7-8 yrs F/U and 40.724 PYs) shows an overall increased cancer risk for CLE (SIR 1.35)and SLE (1.45), esp a 3-4 fold increased risk for NHL, hematological, pancreatic and lung cancers https://t.co/MFPLG9ifGU

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One-Third Rheumatoid Risk from Lifestyle Analysis of the NHANES data suggests that 1/3 of the risk of developing RA in the USA is attributable smoking, obesity and alcohol intake. https://t.co/SAVzBGlAoP https://t.co/bIhmCkufmC

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Best of 2021: Israel provides COVID vaccine answers for rheumatic disease patients https://t.co/3mWEjdAnLL https://t.co/It5VjbQMoI

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Rheumatologist survey - How do you aspirate (or injx) a knee effusion - what is your needle approach?

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Best of 2021: Seronegativity in RA studied using sera and microarrays from 559 RA (283 ACPA-) found 9 autoAbs w/ >90% specificity for seroneg RA. anti-PTX3 & anti-DUSP11 had best performance w/ sensitivity 38% & specificity 88% https://t.co/jFAnpQzmve

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Best of 2021: Cutaneous manifestations of ANCA-assoc vasculitis studied in 1184 GPA, MPA, EGPA pts and found to assoc w/ more severe disease. Common were petechiae/purpura (15%); allergic Sxs such as pruritus, urticaria, were more common in EGPA

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Best of 2021: Petri et al shows higher HCQ levels associated with reduced thrombosis risk, study of 739 SLE pts - 38 patients (5.1%) had thrombosis. HCQ level lower in thrombosis pts (720 vs 935, p=0.025). 69% decr in VTE when levels >1068 ng/mL vs <648 ng/mL

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Best of 2021: Colchicine suppresses MSU & CA pyrophosphate crystal activation of Nod-Like Receptor Protein 3 (NLRP3) inflammasome, thereby suppressing caspase-1 activation and the subsequent release of IL-1β and IL-18. Great review by Pillinger et al

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Best of 2021: Metanalysis of Rituximab use in EGPA (Churg-Strauss) found 19 cohort studies, 8 case series, 18 cases, for a total of 368 EGPA patients. RTX yielded 80% w/ complete or partial remission (w/ more complete responses in pANCA+ pts) https://t.co/cIu6V6Cg8W https://t.co/Pw0ZpqqcB7

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Best of 2021: Plasmapheresis Indications : TTP, HUS, Cryoglobulinemia, Hyperviscosity, Myasthenia gravis, Goodpastures, Catastrophic APL Syn, Chr inflamm demyelinating polyneuropathy, Removal of drugs/toxins, Alveolar hemorrhage, ANCA vasculitis (questionable)

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Best of 2021: ProDERM Study: IVIG in Dermatomyositis--The ProDERM study show that IVIg is safe, effective and superior to placebo in patients with dermatomyositis (DM). https://t.co/l15ZLBguxH https://t.co/7s23FeUf5g

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Dr. Jack Cush tells his podcast story - the genesis, keys to success and recommendations on how to get into podcasting - for teaching, practice, fun or influence. https://t.co/l4emmdM056 https://t.co/uavfamjfI8

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