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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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Worrisome Maternal Mortality with COVID-19 Infection

d Jack Cush, MD

Maternal and fetal outcomes during the COVID-19 pandemic have not been well studied; yet a new retrospective study from Mexico indicates that during the pandemic maternal mortality increased by nearly 57%, with COVID-19 as the cause in 23% of cases.

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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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Lupus Research Alliance has awarded $3 million Global Team Science Awards to Drs Virginia Pascual (Weill Cornell Med Schoo) and Ignacio Sanz (Emory Univ Medial School) for their proposed collaborative, translational lupus projects. https://t.co/ecMlHiZfwe

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Maker Trade name Generic PFIZER Comirnaty Pfizer-BioNTech COVID-19 Vaccine FDA approved MODERNA Spikevax Moderna COVID-19 Vaccine - EUA currently J&J (pending) Janssen COVID-19 Vaccine- EUA currently https://t.co/MM7XiSCczl

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Interested in becoming a rheumatologist? It’s interview season! Dr. Kathryn Dao (@KDAO2011 ) shares tips for the interviewer AND the candidate. #RheumNow #RheumTwitter https://t.co/eWQs9CwqSm https://t.co/7FrkCWoAe8

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Addendum: Other conditions w/ a 1.2-2 fold higher risk of COVID death (admission) were CKD, hematologic cancer, epilepsy, COPD, CVD, stroke, atrial fibrillation, CHF, thromboembolism, PVD, type 2 diabetes. https://t.co/bbDsb1zLhX

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Addendum: COVID deaths increased w/ age, deprivation, male, Indian & Pakistanis. Highest risk w/ Down’s syndr (HR 12.7), renal transplant (8.1), sickle cell (7.7), Nursing home (4.1), chemotherapy (4.3), HIV/AIDS (3.3), liver cirrhosis (3), CNS dz (2.6) https://t.co/bbDsb1zLhX

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Breakthrough infections from UK QResarch database: Among 6.95 million vaccinated, 74.1% recv two vaccine doses, there were 2031 covid-19 deaths & 1929 hosp admissions; ~4.0% deaths & admissions were >14 days after 2nd dose https://t.co/bbDsb1zLhX

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Have you seen this download? How to define difficult RA--download now. https://t.co/6WGMEieHvK https://t.co/yYZdfyUQu0

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Claims case-controlled study shows statin use does not increase the risk of #RA - 32,726 RA and matched controls ; statin use (34 vs 32%) slightly increased RA risk (OR 1.12, 1.06–1.18), but signif lost after correcting for hyperlipidemia https://t.co/EcTlyE1MPx

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Analysis of existing #COVID data - as of 7/15/21, 114.9 million adults infected with COVID-19 in US. Overall population immunity (Infx+vax) is 62%, highest in adults >65yrs (77.2%); lowest in children <12 yrs (17.9%) https://t.co/EYiBUaQBLY

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"In medical school, they spend days teaching people to operate on lungs, and no time at all helping young doctors learn how to get their patients to stop smoking and get vaccinated." - Seth Godin https://t.co/YIk0O0kDTB

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