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All in the Family (8.23.2024)
Dr. Jack Cush picks highlight reports from the past week on RheumNow.com, with reports on the challenge of lupus nephritis, perplexing skin issues, you don't know JAK (about Tyk) and the value of a good family history.
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Pulse Steroids with Tocilizumab in Giant Cell Arteritis
A pilot study assessed pulse methoprednisolone with weekly subcutaneous tocilizumab (TCZ) in patients with large vessel-GCA (LV-GCA) and showed that a sizeable minority will relapse after the TCZ is discontinued.
Sequential Belimumab and Rituximab in SLE
Could disease control in active systemic lupus erythematosus (SLE) patients be improved by the sequential use of subcutaneous belimumab (BEL) and intravenous rituximab (RTX)? A double blind trial has shown that sequential BEL and RTX was not superior to BEL alone in SLE.
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Less Mortality with GLP-1 Agonists in Rheumatic Patients
A recent article in PLOS ONE has shown that treatment of type 2 diabetes with glucagon-like peptide-1 receptor agonists (GLP-1-RAs) was associated with a significant lowering of risk of all-cause mortality and major adverse cardiovascular events in patients with immune-mediated inflammatory diseases and type 2 diabetes.
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The new Covid KP.2 booster vaccines are becoming available throughout the US. Besides high-risk (e.g. age 65+, immunocompromised, comorbidities), one of the most important reasons to get boosted, often overlooked, is to reduce #LongCovid risk by ~50%. Agree with Marks at FDA… https://t.co/SgX7JiPRzH https://t.co/i0W4xadxjW
Links:
Eric Topol EricTopol ( View Tweet)
Check out a NEW review on the dichotomy of #glucocorticosteroids treatment in #rheumaticdiseases by @maurizio_cutolo and team
👉https://t.co/6c08ucQlDN
👨🎓Glucocorticosteroids - a double-edged sword https://t.co/VdKlPzFpOb
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@ReumatologiaJ ReumatologiaJ ( View Tweet)
RISE registry study shows Prednisone Rx before rheum consult ends up with more long-term Pred. 1,733 RA pts; 715 on GC (41% 0.5-2 mos before rheum care). mean GC use =157 d. GC before rheum care associated with longer GC use https://t.co/UpeK4hwIN0 https://t.co/F8cuoX0ACq
Links:
Dr. John Cush RheumNow ( View Tweet)
Sequential Belimumab and RTX in SLE
Could disease control in active SLE patients be improved by the sequential use of subcutaneous BEL and intravenous RTX? A double blind trial has shown that sequential BEL and RTX was not superior to BEL alone in SLE.
https://t.co/CO0ltRX9Eo https://t.co/zey2UE4BRu
Dr. John Cush RheumNow ( View Tweet)
Retrospective study of 919 RTX-treated GPA pts shows TMP-SMX prophylaxis (given to 31%) assoc w/ reduced serious infections (adj HR 0.5) and less outpatient infections (aHR 0.8). All 13 pneumocystis infx (PJP) occured in those not Rx w/ TMP-SMX. https://t.co/bO6oAHv7Lr https://t.co/fPntW75hnY
Dr. John Cush RheumNow ( View Tweet)
Cohort of 112 VEXAS pts: skin involvement common (83%), esp early w/ LCV (36%), neutrophilic (34%) or perivascular dermatitis (30%). p.Met41Leu variant w/ PMN (Sweets?) dermatitis (82%); p.Met41Val variant w/ vasculitic lesions (55%). 92% respond to pred https://t.co/2ACXCGRsi5 https://t.co/tYqA26AlaF
Dr. John Cush RheumNow ( View Tweet)
Biologic Rx may be less effective in psoriasis pts who are older, smokers, w/ Hi BMI & prior biologic use. Metanalysis of 40 studies, 21 438 PSO pts, and PASI90 responses. Decr Response w/ age (OR 0.99), Biologics (0.44), BMI 30+ (0.57), smoking (0.81) https://t.co/uhFFIwNKB7 https://t.co/LaznQ0M9UG
Dr. John Cush RheumNow ( View Tweet)
Pulse Steroids with Tocilizumab in Giant Cell Arteritis
A pilot study assessed pulse methoprednisolone with weekly subcutaneous TCZ in patients with large vessel-GCA (LV-GCA) and showed that a sizeable minority will relapse after the TCZ is discontinued.
https://t.co/gGrSY3U1t9 https://t.co/zuspadaY9t
Dr. John Cush RheumNow ( View Tweet)
Overview of Cannabinoids for Rheumatic Pain disappoints because not much is really known or studied well. They may improve pain, but come w/ mild-mod side effects. Conflicting evidence contributes to practitioner and patient uncertainty https://t.co/eI07SXbbem https://t.co/ZDvdFcLXh4
Dr. John Cush RheumNow ( View Tweet)
Metanalysis of 50 RCTs (3,231 pts w/ lupus nephritis (LN) related starting pred dose to rates of complete response (CR), serious infections, & death. PO pred 25 mg/D assoc w/ 20%, 3.2% & 0.2%, respectively. Pred 60 mg/day incr rates to 35%, 12% & 2.7% https://t.co/6FH9BWsmaz https://t.co/0cQPAIuvRw
Dr. John Cush RheumNow ( View Tweet)
ASLeap: Higher Dose Secukinumab in Ankylosing Spondylitis
Ankylosing spondylitis (AS) patients not responding to usual dosing with secukinumab (150 mg) after 16 weeks were dose escalated to SEC 300 mg, but failed to show improvement by week 52.
https://t.co/EJvoBlW9or https://t.co/tYb1fIA3pw
Dr. John Cush RheumNow ( View Tweet)
Metanalysis of 16 RCTs shows febuxostat reduces the risk of kidney events (RR = 0.56, 95% CI 0.37-0.84, p = 0.006) and a slower decline in eGFR (vs controls) https://t.co/9YAxTrHFVQ https://t.co/ZyRE7R6P4a
Dr. John Cush RheumNow ( View Tweet)
Anti-CD40 Therapy in Sjögren's Disease
Iscalimab, a CD40 monoclonal antibody, showed + results in treating Sjögren's disease, an autoimmune condition lacking effective therapy. The TWINSS study demonstrated iscalimab's safety/efficacy in a phase 2 trial.
https://t.co/aanI9K83XP https://t.co/qJhgHDFCVY
Dr. John Cush RheumNow ( View Tweet)
Pregnancy, menopause, contraceptives, hormone replacement, aromatase inhibitors may affect lupus outcomes. Review says hormone therapies are contraindicated w/ antiphospholipid syndr, APL Ab positivity, and uncontrolled SLE or flares https://t.co/bZQr8b871n https://t.co/OmXY04GR4p
Dr. John Cush RheumNow ( View Tweet)
Romosozumab vs. Teriparatide in Postmenopausal Osteoporosis
The effectiveness/safety of ROMO and TPTD were compared in a clinical setting, and ROMO showed greater increases in BMD than TPTD after 12 months of therapy, along with a higher completion rate.
https://t.co/iKKLruiiay https://t.co/vPKa8pom7e
Dr. John Cush RheumNow ( View Tweet)
Favorable results from Vasculitis Pregnancy Registry; enrolled 147 women, 149 pregnancies; data on 78 pregs. 36% had active vasculitis during Preg, 14 hospitalized (4 w/ vasculitis. 74% Rx vasculitis meds during preg & 97% live births, 21% preterm https://t.co/rq2Y4ij0OW https://t.co/wmmFPvlOGY
Dr. John Cush RheumNow ( View Tweet)
