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Burnout #10 (2.3.2023)

Dr. Jack Cush reviews the past week of news on

  1. Swiss RA registry assessed outcomes after 1st JAKi. 400 RA pts starting/failing JAKi were switched to 2nd JAKi or TNFi or other MOA biologic. ~40% had prior bDMARDs. Retention was higher w/ 2nd JAK (918d)i vs other options. TNFi (335d) or OMA (918d).
  2. Is JAKi therapy safe in RA-ILD pts? Italian retrospective study (2018-June 2022) w/ 43 RA pts & HRCT proven ILD (med age 69yrs) & Rx w/ JAKi. After 19 mos F/U, the FVC was stable in 79%, improved in 11%, & worse in 11%. DLCO & HRCT trend was similar.
  3. PNAS has a novel approach to #RA Tx; bioengineered probiotic (Lactobacillus reuteri) orally delivers a peptide Kv1.3 channel blocker to RxRA. Kv1.3 is expressed on CCR7− effector memory T cells. Blocking Kv1.3 improves RA & PSO in rat models.
  4. The EMAs CHMP has recommended granting a marketing authorisation for Sotyktu (deucravacitinib) for the treatment of moderate to severe plaque psoriasis in adults.
  5. Retroperitoneal fibrosis Tx is fraut-steroids, tamoxifen, MMF, B cell therapy? OL trial in 8 RPF pts used steroids & mTOR inhibitor sirolimus (2mg/d x 3d; 1mg/d); 12 & 48wks - decr in fibrous tissue 50%, ESR 70%, IgG4 50% w/ normalized renal funct.
  6. Studies in 76 systemic sclerosis (SSc) pts (& animal models of SSc) show fibroblast A20 (enzyme) is downregulated and promotes fibrosis in SSc; but is repressed by DREAM, an A20 negative transcriptional regulator.
  7. US population mortality rates compared dermatomyositis (DM) vs polymyositis (PM) in 1981 (12,249) & 2020 (23,608). Downward trend in DM/PM mortality (<7%); plus PM/DM was 2X more likely to be one of mult causes, instead of, sole cause of death.
  8. Systematic review of MRI confirm degenerative meniscus tears compared arthroscopic meniscectomy (APM) vs non-surgical or sham Rx. Results: 10 trials, 605 patients showed at 24 mos F/U, no advantage in Function or QOL favoring APM - rec conservative Rx
  9. Amgen launched its adalimumab biosimilar - Amjevita ( FDA approved in 2016), has 2 different discounts— 55% or 5% below Humira's (list $6,922/mo). Another report says Amjevita 40mg given q 2wk will cost $40,497 - $85,494 annually
  10. 1st there was combined Rheum-Derm or Rheum-Pulm clinics. Medscape reports new Rheum-Cardiology clinics at Cleveland Clinic, NYU, Brigham, Stanford. Useful in research, managing Rheum pts a) at hi CV risk, B) having procedures/surgery, c) risk reduction
  11. FDA has approved the 1st BTK (Bruton’s tyrosine kinase) inhibitor (Jaypirca™ or pirtobrutinib) for adults with refractory mantle cell lymphoma. BTK inhibitors are also being developed for use in MS, RA, SLE, pemphigus & more
  12. Study of 58 pediatric patients with Kikuchi-Fujimoto disease saw 15 (26%) with Macrophage Activation Syndr. KFD-MAS+ pts had signif. more skin rash (27%), Steroid Rx(80%), Dz recurrence (33%), lower cell counts (WBC, plt, lymphs) & higher LDH.
  13. ANCA assoc Vasculitis pts in RAVE - treated w/ RTX or CTX, thenAZA. 18/22 severe infections occurred within 6 months. Predictors of severe infx included higher baseline CD19+B cells & PJP prophylaxis w/ TMP/SMX (both groups Rx RTX or CYC/AZA)
  14. Herpes Zoster with JAK Inhibitors
  15. Physician Burnout Remains, Less So in Rheumatology
  16. RheumNow.Live - register now for our hybrid meeting March 18th & 19th 


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