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No Recurrent Cancer Risk With Biologic Treatment of RA

d MedPage Today

Patients with rheumatoid arthritis (RA) who had a history of cancer did not have an increased risk of new or recurrent cancers if treated with biologic therapies, a meta-analysis found.

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RheumNow Podcast – I Wanna New Drug.V2 (9.24.2021)

d Jack Cush, MD

Almost three years ago to the day, I did a podcast entitled, "I wanna new drug." As I go over this week's podcast, I want to say it again. I want a new drug safe enough to use during pregnancy, for PMR, for GVHD, and more. I'm going to cover these, and other topics including lupus, COVID breakthrough infections, and statin use and the risk of RA, as I review the news and journal articles from the past week on RheumNow.

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Guselkumab Treats Axial Disease in Psoriatic Arthritis

d Jack Cush, MD

Pooled analysis of the DISCOVER-1 and DISCOVER-2 trials have shown that guselkumab, an IL-23 inhibitor, was effective and safe in psoriatic arthritis (PsA) patients with axial involvement and imaging-confirmed sacroiliitis.

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11 Drugs That Cause Arthritis

d Jack Cush, MD

This is the #1 question I get from new consults: “How did I get arthritis?”

But as the aching are asking, they are really thinking these joint complaints must be due to something.

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IL-6 Inhibition in Refractory Systemic Sclerosis

d Jack Cush, MD

A small, single-center cohort analysis of difficult, refractory systemic sclerosis (SSc) patients showed that treatment with tocilizumab (TCZ), an interleukin-6 inhibitor, resulted in significant improvement in joint and skin involvement, regardless of SSc disease duration or subtype. 

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Tocilizumab and Drug Shortage Headaches

d Jack Cush, MD

Do you know what’s in short supply? Trust, pediatric rheumatologists, and drugs. Since the onset of the pandemic, numerous drug shortages have affected rheumatology, including sulfasalazine, hydroxychloroquine, and now, tocilizumab.

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High Comorbidity Rates with Inclusion Body Myositis

d Jack Cush, MD

Inclusion body myositis (IBM) patients tend to be older than those with idiopathic inflammatory myositis (IIM), but the scope of disease beyond their myositis is not appreciated.

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Study of 435 #SLE pts seen during the pandemic. Comparing those seen F2F vs telemedicine, there was no significant difference in SLE disease activity (by SLEDAI-2K) or SLE flare rates or steroid prescribing between visit types https://t.co/kscU9CbqVM

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Prescribe antimalarial dosages at 5 mg/kg/d or less.... A baseline retinal exam w/ optical coherence tomography should be performed w/in 6 mos...to rule out confounding Dz. Pts at low risk for retinopathy do not require annual screening until 5 years.. https://t.co/l3sCxOJLNJ

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Encouraging DBRPCT of Rituximab in #PMR: 116 screened, 49 enrolled, 47 completed: 23 on RTX vs 24 on PBO. Steroid-free remission at 21 wks seen with 11/23 (48%) RTX pts vs 5/24 (21%) on PBO (p=0·049). Infusion Rxns: 10 RTX vs 3 PBO); 1 SAE (PE) on RTX https://t.co/U2ZGNrpi0i

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JAKi vs bDMARDS in Real World Data https://t.co/7P6zvp45vH

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Pregnancies exposed to ixekizumab (from Eli Lilly Global Safety Database) found 193 pts with psoriasis, PsA, or axSpA who were IXE exposed. Live births reported for 53.8 and 61.1% of known outcomes. No congenital malformations seen. https://t.co/M1rvCH81hT

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The EMA has recommended Nucala (mepolizumab) as an add-on treatment for patients aged 6 years and older with relapsing-remitting or refractory eosinophilic granulomatosis with polyangiitis (EGPA) https://t.co/0aVoDpaTPT

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FDA approves Jakafi for chronic GVHD. Ruxolitinib (Jakafi, Incyte), an oral Janus kinase 1/2 inhibitor, previously received approval for treatment of patients aged 12 years or older with steroid-refractory acute GVHD. https://t.co/isItDebNZ8

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Insurance data (biologics only given to refractory pts) study of 249 (TKR) & 159 (THR) surgeries in ~6000 #RA pts. Pts on biologics had signif less TKR (aHR: 0.55) & THR (0.63) vs higher rates if on MTX, steroids, biologic switch or APL syndr https://t.co/4rwuYswqz7

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Retrosp. review of 10–24 yr olds w/ newly Dx #SLE shows 78% given steroid-sparing DMARDs by year 1; Most (69%) given HCQ & fewer (34%) given other immunosuppressants. Adults less likely to recv immDMARDs @1 yr https://t.co/aLi6FXlMd3

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VAMC case controlled study shows CPPD pts have nohigher risk for MACE. 23,124 CPPD vs 86,629 non-CPPD, w/ >250,000 Pt-Yrs FU. CPPD MACE risk not increased (HR 0.98), but there was incr risk of MI, CVA & acute coronary syndr. https://t.co/pgmZBxTg9O Conclusions

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Prospective study of 77 RA patients in remission --> vax w/ BNT162b2 (BioNTech-Pfizer) (w/ temp D/C of DMARDs per ACR) found a vaccine-related flare rate of 7/8% (6 pts) w/ 5/6 flares after 2nd dose (2.6 days), resolved w/in 2 wks https://t.co/YOL3YVS2ne

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Regarding Pfizer 1133 tofacitinib Safety study and recent FDA JAKi warnings -- Dr. Roy Fleischmann has said, "“There is a small increase in risk,” “But is it clinically meaningful?”, Read full interview here https://t.co/2Wd5h69Dfq

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MMWR reports real world vax efficacy in 3,689 adults (21 states) found better results w/ Moderna (93%) than Pfizer (88%) than Janssen (71%). 2 dose mRNA vaccines were more effective than 1 dose Janssen COVID vaccine https://t.co/phmPdB9dTW

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