Ides of March (3.15.2024) Save

Dr. Jack Cush has advice for Caesar and the superstitious, and covers pregnancy, platelets, dialysis and vaccinations in Lupus.

1. Dutch study of 586 RA pts on bDMARDs found more nonserious infections (NSIE) (77/100PYs) than serious infx (SIE)(1.3/100Pys). Upper respiratory tract infections were most frequent with recurrence rate that remained stable over time https://t.co/zwELL2yevG

2. Japanese study of 672 autoimmune pts on TNFi & tocilizumab - 1.6% (n=9) developed non-tuberculous Mycobacteria (NTM) infx post biologics. 2 disseminated NTM, 2 died. NTM pts had higher mortality [(22% vs 2.6%) & took more steroid (17 vs 3 mg, P=0.004). https://t.co/cLqt3FSzBk

3. H. Pylori is usually acquired during childhood, remains dormant until activated years later. Is assoc w/ PUD and gastric cancer, not dyspepsia. Baylor Univ Grand Round By Dr. Byron Cryer @BCryer https://t.co/KXZfigVYX9

4. Testing for H. Pylori. Serologic tests are OK but after Rx eradication, 25% of pts will remain positive for H. Pylori. @BCryer

5. Long-term safety of Ixekizumab (IXE) - 26 RCTs (22k PYs) in PSO, PsA, AS & nr-axSpA - nasopharyngitis most common AE; AEs did not incr over time - D/C from AE 3-5/100Pys - ISRs: 5.9-11.6/100PYs - Candida 1.2-2/100PYs - IBD: 0.1 PsO - 0.8/100PY for axSpA https://t.co/nOoCE3VOxD

6. Japanese study of 96 #SLE pregnancies: 59 in remission @ conception. Remission had fewer adverse preg outcomes (OR 0.27) vs those w/ activity. No difference in APO based on serologies, but Pred ≥7.5/d us had signif. more APO. (OR 3) https://t.co/BvOeiSERN9

7. Chinese SLE registry study of 350 SLE-TP (low plts) pts - 55% were aPL Ab+ (who had lower Plts @baseline (61K vs 76k). aPL+ SLE-TP pts w/ higher relapse rate (58% vs. 44%, P=0.009) & lower complete response rate. > more aPLs--> increased relapse rates https://t.co/Mb2YhsniVJ

8. SLE & remission on hemodyalysis (HD)? Cohort of 137 pts starting HD & the # off SLE Rx increased w/ time: 67% (HD start), 76.0% (1st Yr), 83% at 3 yrs (less w/ younger). Lupes flares most in 1st yr of HD; @12 mos 52% minor and 12% had severe flares. https://t.co/8N7CJWkIUY

9. Vaccinations NOT linked to SLE risk. 17 studies (45 million) w/ F/U up to 2 yrs. No signif SLE risk: - all vaccinations (OR=1.1; CI 0.86–1.5) - HBV vax (OR=2.11; 1.11-4) - HPV (OR=1.4; 0.88–2.3) - Flu (OR=0.96; 0.82–1.1) - COVID (OR=0.44; 0.18–1.2) https://t.co/YpxSYL97DM

10. DANBIO #RA registry study: in 21,982 Rx starts (96K PtYrs) saw 1423 cancers w/ no overall increase in cancer risk with tocilizumab, sarilumab, abatacept, or rituximab (HRs from 0.7–1.1). No diff betw ABA vs TNFi (HR 1.41) nor HEME CA RTX vs TNFi (HR 0.09) https://t.co/mIEqALnnwI

11. JAK-pot: 46913 Rx courses on JAKi, TNFi, other MOA. Rx D/Cs for AEs: - TNFi = JAKi (HR 1.0) - Other MOA > JAKi (HR 1.11) - TNFi < tofacitinib (0.81) - TNFi > baricitinib (1.15) - TNFi < JAKi; if >65yrs w/ CV risk (0.79) https://t.co/N5XnPjxAXO

12. JAK inhibitors maybe an option in refractory Juvenile Dermatomyositis. Metanalysis of 26 reports (195 pts) JDM Rx w/ JAKi (median 5 rys); most Rx w/ tofacitinib (57%), ruxolitinib(27%), baricitinib (15%), w/ Improvement in 90%, 69%, 93%, respectively. https://t.co/acdlU13MfX

13. Review article on inclusion body myositis, a progressive, debilitating myopathy w/ onset > 50 yrs. IBM typically has asmmetric, painless, weakness & atrophy of finger flexors or quadriceps w/ dysphagia. Most are wheelchair bound w/in 13-15 years https://t.co/LoWtmDqimu

14. Again, a High Mortality with Depression and RA