Drug Safety

This year at EULAR 2022, there were important and interesting topics in Axial Spondyloarthritis (AxSpA). These are my picks of abstracts from the conference.

Dr. Jack Cush reviews recent news, regulatory and guideline updates from the past week on RheumNow.com.  Studies on methotrexate use, COVID vaccination, Supplements and vitamins, and arthrocentesis despite anticoagulation are discussed.

A new way of inhibiting tumor necrosis factor (TNF) for treating rheumatoid arthritis showed strong results in a phase II/III clinical trial, researchers said.

Analysis of two large clinical trial datasets shows that placebo response rates in randomised controlled trials (RCTs) of patients with rheumatoid arthritis are better when the patient continued background methotrexate (MTX). 

The GRAPPA (Group for Research and Assessment of Psoriasis and Psoriatic Arthritis) treatment recommendations have been updated and the 2021 evidence-based guidance is rich in treatment recommendations based on the key disease "domains" - peripheral arthritis, axial disease, enthesitis, dactylitis, skin and nail psoriasis; with new PsA related domains uveitis and inflammatory bowel disease.

Recent FDA and MMWR warnings suggest that gabapentin was present and implicated in almost 10% of US overdose deaths between 2019 and 2020. This CDC report also stated that gabapentin was the cause of the death in half of these cases. 

Hydroxychloroquine (HCQ) appeared less safe from a cardiovascular standpoint than methotrexate in older patients with rheumatoid arthritis (RA), analysis of Medicare data indicated.

The US Preventive Services Task Force (USPSTF) has updated its recommendations regarding the efficacy of supplements or multivitamins for reducing the risk of cardiovascular disease, cancer, and mortality in the general adult population.

Pooled data from two large ixekizumab (IXE) trials show that male patients had greater clinical responses than did female patients with psoriatic arthritis are largely unexplored. Reasons for this differential treatment responses to an interleukin-17A inhibitor (IXE) between male and female patients is unexplained.

A pooled analyses of data from eight, phase 2 and 3 randomized clinical trials shows bimekizumab, a dual IL-17A/F inhibitor, to be effective in plaque psoriasis and was well tolerated aside from an increased incidence of mild to moderate oral candidiasis. 

Aside from cost, there are significant concerns regarding efficacy and safety outcomes and recovery time. These issues are compounded with the need for bilateral TKR, wherein the patient and surgeon need to decide whether to have both TKRs done simultaneously or staged (single TKR one after another with a recovery period in between).

Dr. Jack Cush does a 2-week review of RheumNow Tweets on news and journal citations worth noting, along with some opinions on Telehealth, manpower, monkeypox and the price of drugs. Although Rheumatology currently ranks 2nd or 3rd in specialty use of telemedicine - the vast majority of rheums have given up on telehealth (<15%) https://t.co/iDNesBkOnN

Insurance claims analysis has shown that the use of the (CDC recommended) recombinant zoster vaccine (RZV) for prevention of herpes zoster was highly used in patients with immune-mediated inflammatory diseases and was safe, as higher rates of arthritis flares were not evident.

A retrospective cohort study has shown that outcomes in pregnant systemic lupus erythematosus (SLE) patients has significantly improved in the last decade, but there still is a high risk of adverse pregnancy outcomes (APO). A retrospective Danish SLE cohort was used to identify pregnancies in SLE patients from a single center between January 2010 and October 2020.

Dr. Jack Cush reviews the top abstracts from EULAR 2022  As chosen by me with the  aid of the RheumNow EULAR faculty. “Top” is relative and subjective, but my criteria for inclusion are based on impact, water cooler talk potential, innovation and social media buzz.  Speaking of social media…