I Can't Treat Ugly (9.20.2024) Save

Dr. Jack Cush reviews the news, journal articles and a new FDA approval for EGPA, this week on the Podcast.

1. PEDIALUP registry includes 138 childhood-onset SLE (cSLE) pts.w/ 15.4 yrs median F/U, showed signif increase in SLICC-damage index (DI) scores. 34% cSLE pts had active dz w/ SLEDAI ≥6. sub-Saharan African ethnicity 7-fold incr risk of active cSLE https://buff.ly/3zg3idl
2. Increased Cardiovascular Events in Lupus A New York surveillance registry (Manhattan Lupus Surveillance Program) estimates higher rates of CVE among SLE patients, especially amongst younger males, Hispanic/Latinos and non-Hispanic Black patients. https://t.co/aUZreOSbaD
3. Exploratory analysis from an academic center showed SLE pts w/ higher odds of positive ANA vs. other ANA-asso diseases (OR 2.10). Over 20 yrs, ANA titers are more dynamic than expected; & average titers being higher in early disease and decreasing over time. https://buff.ly/3XAfU6S
4. Study of 115 systemic sclerosis (SSc) pts followed 4 yrs. modified Rodnan skin score @ 4 yrs correlated w/ baseline mRSS & finger-to-palm distance (length from the distal tip of the fourth finger to the distal palmar crease) https://t.co/TwMy5Mh68r
5. Metanalysis of JAKi in ILD (7 studies, 183 pts) showed increases in FVC (2 %), DLCO (3.1%) & improved Thoracic HRCT of 11%; only 5% had worsening of their ILD. Risk of ILD w/ JAKi was low (0.20/1000 PY) w rates similar to abatacept & rituximab https://t.co/EDaVC6RyZs
6. Retrospective analysis of 63K Alopecia areata pts shows a higher risk of developing psychiatric (aHR 1.3) & autoimmune Dz (aHR 2.7), including SLE (aHR 5.7), atopic dermatitis (4.3), vitiligo (3.8), Sjogrens (3.7), Morphea (3.6), PsO (2.8), RA (1.8) https://buff.ly/3ZCI57Q
7. Fasenra (benralizumab, an anti-IL-5 mAb) has been FDA approved in the US for the treatment of adult patients with eosinophilic granulomatosis with polyangiitis (EGPA); approval based on MANDARA trial - H2H noninferior to mepolizumab at remission https://t.co/YmpOCcivg9
8. 40 postmenopausal F Rx w/ Blackcurrant (BC) vs PBO. @6 mos BC lowered IL-1β (P .056) & RANKL (P .052) & BMD inversely correlated w/ RANKL change. BC bone protective may also be through enhancing gut microbial balance https://buff.ly/3zmnKt1
9. Yes you can space out Guselkumab injx in controlled Psoriasis. Phase 3b RCT of 149 GUS pts w/ PASI <4 were cont on GUS q8 wks or spaced to q16wks. Noninferiority was shown w/ maintenance of "super-responders" in > 90% w/ both https://buff.ly/4dfrp9U
10. Swedish population/registry study of incidence of Psoriatic arthritis was estimated at 21.8/100 000 person-years (15.78-28.83/100 000 PY); slightly higher in females, lower w/ higher education, peaks 50-59y. 71% were on DMARD w/in 2 yrs (22% b/ts DMARDs) https://t.co/YTNBHczZ7X
11. Cancer presenting as Inflammatory low back pain? 34 Cases presenting as SpA over 10 yrs often w/ higher ESR/CRP/LDH levels. CA included myeloma, leukemia, lymphoma, CA of breast/lung/prostate & bone tumors. https://t.co/YYKYx39tbD
12. Chinese study of 62 Systemic JIA pts Rx w/ IV Tocilizumab (34 12 mg/kg; 28 8 mg/kg). Wk12 87% responded (JIA ACR 30w/ no fever); Week 52 results were similar. No deaths or macrophage activation syndrome occurred. https://t.co/qGgMCt597x
13. REAL-HLH, a retrospective study of emapalumab (anti-IFNg) was effective in Rheum (15 pts) w/ hemophagocytic lymphohistiocytosis (10 w/ Still's disease, 60% in ICU w/ refractory Dz). EMA normalized CXCL9, ANC, decr steroids & had 12 mo survival=87% https://t.co/MgYul9rCqV
14. IMPORTANT: Cost effectiveness analysis of the TREAT EARLIER RCT shows 88% probability that 1 yr of MTX in 236 pts w/ clinically suspect arthralgia was cost-effective. Results shows MTX Rx increased quality adjusted life years & reduced costs https://t.co/1BVxs77vo8
15. TREAT EARLIER - Methotrexate in Clinically Suspect Arthralgia Patients 
16. FOREMOST: Apremilast in Early Oligoarticular Psoriatic Arthritis  

“Big doors swing on little hinges.” - W. Clement Stone https://t.co/wLfKpwUxzc