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RheumNow Podcast – Ghastly, Ghoulish News (10.31.19)

Nov 01, 2019 8:39 am

Dr. Jack Cush reviews recent journal articles and info bits from the past week on 

  1. Data on 14 261 PsA patients (from 11 European registries) startin TNFi therapy - shows that half (56%) were in DAS28 remission and 53% were ACR20 responders after 6 months, and 3/4 were still on TNFi at 1 year
  2. Audio-recorded analysis of Rheum consultations & "shared-decision making" (SDM) scored 0-100. The mean wasn’t very good = 28.3 (SD=15.1). Higher SDM assoc w/ consultation duration, discussion of Rx start/stop/adjustments. Better visits take time & talk. 
  3. Claims analysis of psoriasis & PsA treated with inhibitors of TNF , IL-17 (SEC, IXE) or IL12/23 (UST) (2015-18) shows 2% of biologic starts had serious infections. SIE rates equal for TNFi & IL-17i; but were lower for IL-12/23 vs TNFi (HR=0.59; 0.39 -.90)
  4. Metanalysis of multi‐biomarker disease activity (MBDA or Vectra) score & RA disease activity looked at 22 studies showing modest correlations w/ DAS28‐CRP (r 0.41) & DAS28‐ESR (r 0.48), but weaker correlations with SDAI, CDA (r 0.26) and RAPID3 (r 0.23)
  5. Persistently frequent use of emergency department (ED) by lupus patients was primarily for pain by SLE pts who were more apt to be on narcotics. Pain management in SLE appears to be a significant challenge, if not unmet need.
  6. Study of 238 PsA patients starting a biologic shows that comparing those w/ comorbid FM vs without, PsA pts with FM had lower biologic survival (50% vs 74%) and PsA-FM unlikely to achieve remission (3.4% at 3mos and 0% at 6 months).
  7. Metanalysis of 373 citations and 14 studies was unable to prove a protective X-ray benefit of TNF inhibitors in patients with axial spondyloarthritis.
  8. Claims study of 253K csDMARD #RA showed switching to biologics/targeted synthetic DMARDs had increased risk of venous thromboembolism (HR 1.36 ;1.16, 1.58); Compared to 1st b/tsDMARDuse; VTE was higher for 1st (1.35) and 2nd b/tsDMARD switchers (1.48)
  9. Common Physician HIPAA Violations   
  10. Frequent DMARD Discontinuations During Rheumatoid Pregnancies  
  11. Methotrexate and the Risk of Lung Disease  
The author has received compensation as an advisor or consultant on this subject

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