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Anti-Drug Antibodies with Biologics (7.14.2023)

Jul 14, 2023 3:22 pm

Dr. Jack Cush Reviews the news and journal reports on CVA, TKA, PJP, ADA, and more!

  1. Pain is the leading cause of disability worldwide. Chronic pain affects 33-50% of the population. High impact chronic pain is seen in 4.8% of US adult population. Chronic pain accounts for 22-50% of GP consultations. More from BMJ..
  2. NIH MOST study 2093 OA pts w/ Knee Xrays/CT/Pain scores q8 mos x2 yrs. IA mineralization seen in 10% knees & assoc w/ a 2 fold higher risk of freq knee pain & OR 1.86 of freq intermit/constant pain. IA mineralz. meniscus or Jt capsule=higher odds of pain
  3. Metanalysis of 8 RCT, 188751 pts assessed mortality risk & FM. Overall, all-cause mortality increased in FM (HR 1.27, 1.04 to 1.51), but not in subgroup Dx by 1990 criteria. Increased SMR for accidents, infxn, suicide & decreased for cancer (0.82)
  4. A double-blind, sham-controlled RCT of auricular vagus nerve stimulation (VNS) showed NO meaningful improvement in 101 RA completers. @week 12, ACR20 was 25% for VNS vs 27% for sham (NS). Also NS was change in DAS28-CRP (–0.95 vs –0.66)(p 0.06)
  5. and the Risk of Cerebrovascular Ischemic Events Cerebrovascular ischemic events (CIE) can be one of the most severe complications of giant cell arteritis (GCA), but is seen in 4-5% of GCA patients according to a recent French University Hospital.
  6. Commercial claims analysis of 21,044 pts w/ simultaneous B/L TKA vs 126,264 matched unilateral TKA. 90 day risk showed B/L TKA had signif more pulmonary embolism (aOR 2.13), CVA (2.21), acute anemia (2.06), transfusion (7.8), 90d readmission (1.35)
  7. JAMA: Prophylaxis for Pneumocystis Pneumonia - indications and Rx - Immuncompromised and Immunodeficient - Pts on Hi Dose Steroids - ANCA–associated vasculitis
  8. Baricitinib Effective in JIA Subsets A phase 3 trial assessed a selective Janus kinase 1/2-inhibitor, baricitinib, in patients with juvenile idiopathic arthritis (JIA), demonstrating it's efficacy and safety compared to placebo.
  9. Metanalysis 62 RCTs & 16 LTE RCTs compared neoplasia risk in JAKi, TNFi, MTX, PBO. Overall CA rate=1.15/100PYs in RCTs. No diff in all malignancies between JAKi vs PBO (IRR 0.71; 0.44, 1.15) or JAKi vs MTX (IRR 0.77); but JAKi had more CA than TNFi (1.50; 1.16, 1.94)
  10. Upadacitinib Outcomes in High Risk RA Patients A safety analysis of six phase III SELECT trials showed that higher-risk RA patients had an increased risk of MACE, malignancy (excluding NMSC) and VTE regardless of being treated with either UPA or ADA.
  11. 35 SLE pts Rx w/ RTX x 3 ys-anti-RTX antibodies found @3 yrs in 64%, higher if previously RTX treated (vs naive). ADA+ had signif lower median RTX levels at 6 mos (P = 0.0018) and increased relapse rates. In vitro showed neutralizing capacity these Abs
  12. Antidrug Antibodies Impair Response to Biologic Drugs 
  13. Ask Cush Anything: How to treat RA with nontuberculous mycobacterial infection.

Join The Discussion

Omer Ahmed Hamad Amin

| Jul 18, 2023 4:34 pm

Regarding Anti drug antibodies , is it useful to co-adminster MTX with all biological drugs to decrease anti-drug antibodies or it’s only useful when monoclonal antibodies-TNF group are used (eg: infliximab & adalimumab )
When patient intolerant to MTX ; is it useful to Co-administer other DMARDs (eg Leflunamide or AZA ) instead of MTX to decrease Anti-drug antibodies ? Thanks

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