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RheumNow Week in Review – Vitamin D Falls Again (10.4.18)

Oct 05, 2018 1:09 pm

Dr. Jack Cush reviews the news from the past week on 

  1. Medical marijuana use is up 83% (46K users) in Illinois -with sales of ~$12million/month. Use lead by PTSD (4000) which surpassed fibromyalgia (3400) and cancer (2500)   
  2. Gabapentin (GABA) is 10th most Prescribed drug in USA; 22% of opioid abusers abuse GABA (also high in EU); off label use is pervasive; GABA assoc w/ overdose deaths in Tenn (4%), (15%), NC (20%), KY (41%). Should it be Schedule V 
  3. ILAR/PRINTO Again wants to again redefine JIA - as 4 groups: a) systemic JIA; b) RF+ JIA; c) enthesitis/SpA-related JIA; d) early-onset ANA+ JIA. Hopefully subsets will differ in MOA, outcomes, Treatments and NOT all be reported together in the future.   
  4. Medicare claims data analysis compared 4,551 ESRD/Hemodialysis and 45,510 controls and showed that PPI and H2 blocker use was associated with a 25% and 23% increased risk of Hip fracture. 
  5. Twitter Poll: Often Not discussed but do you combine Otezla with a biologic (TNFi or IL-17 inhibitor) in your difficult PsA patients? Rheumatolgists poll – 81 respondents: 36% No/Never; 26% can’t get approval; 26% yes +benefits; 12% Yes but no benefit.   
  6. RCT Extended vs flexed knee positioning for arthrocentesis in 55 knees (20 vs 35) - Extended knee was 2X better in Syn fluid yield (16.9 vs 5.9 ml) and more succcessful at dx fluid aspiration (99% vs 77%). Mechanical compression equaled out these results. 
  7. ASPECT trial in 1250 Belgians shows a 20 and 30% increased risk of developing IBD & acute anterior uveitis, respectively after 10 yrs of axial SpA; IBD and AAU risk (not psoriasis) related to Dz duration and inflammation, 
  8. TCZ doesn’t meet primary end point in ph3 trial for AOSD but helps⬇️ steroid dose: ACR50 at wk 4 61.5% vs 30.8% PBO but p=0.24. Steroid dose ⬇️ by 46.2% in the TCZ vs 21.0% in PBO group (p=0.017). ACR 20/50/70 84.6%/84.6%/61.5% at wk52 @RheumNow 
  9. JAMA study of 59 FDA approved drugs (138 pivotal RCTs) in 2015-2016 shows the median cost per trial to be $19 million (range, $5 million for uncontrolled 3 orphan drugs to $347 million for noninferiority trial). Noninferiority trials most expensive!   
  10. Vitamin D Fails to Improve Bone Health  
  11. Zolendronic Acid Benefits Elder Women with Osteopenia 
  12. Predictive Risk Factors for Uveitis in JIA


The author has received compensation as an advisor or consultant on this subject

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