Is MTX Safe in the Elderly? (12.1.2023) Save

Dr. Jack Cush reviews this past week's news and journal reports from RheumNow.com. Good news is that nearly 99% of adult rheumatology positions matched! But the challenge is that 45% of pediatric fellowship programs and 39% of pediatric rheum slots were unfilled in the 2024 NRMP match.

1. Study from British Columbia, Canada, showed between 2010 & 2020, they saw 31% more new pt rheum consults (149,902); 1st time consults for inflammatory arthritis incr 28% to 51%. While time to 1st visit decr. 35%, time to DMARD initiation was unchanged https://bit.ly/47OBfNO

2. #ACR23 Abst#1629 from FORWARD registry showed RA pts (n667) with LONG COVID (15%) had worse RA pre-COVID and post-infx, and had worse COVID (more ABx & hospitalization). RA-long Covid pts had 3fold more fibromyalgia (13 vs 41%) https://bit.ly/3t5hDG9

3. Theres a ustekinumab biosimilar, CT-P43 - In a multinational, phase III study in 509 plaque psoriasis pts, CT-P43 was equivalent to the originator, Stelara, with week 16 PASI75 scores of 78% vs 76%, and continued efficacy out to week 40 https://bit.ly/3N56MTs

4. National pharmacovigilance database review (1992 to 2021) identified 2217 "Falls", most serious, most in women (61%), & 38% in 18–64 yr olds. Falls attributed to immunomodulators (17%), 24% Fxs & 1 in 7 classified as adverse drug rxns (343) https://bit.ly/49RJsSZ

5. UK study 336 GCA pts shows after 12 mos of tocilizumab, TCZ stopped (w mean pred 2mg/d) & GCA flares at 6, 12 & 24 mos was 21%, 35% & 49% respectively; requiring prednisolone dose increase to 20 (10-40) mg/day (34% were major relapses) https://bit.ly/49UW2Rj

6. Chemokine CXCL10 a potential biomarker for ILD in systemic sclerosis (SSc)? Study of 165 SSc pts (41 w/ SSc-ILD) found higher serum CXCL10 in SSc-ILD (126 vs. 78.5 pg/ml). Hi levels incr risk of ILD 2.74-fold. Most CXCL10 from inflammed lung tissues https://bit.ly/3Tb1HNv

7. Single center obs. study 74 RA-ILD pts Rx w/ antifibrotics (40 nintedanib; 34 pirfenidone); F/U 89 wks, had signif improvement in FVC estimated decline after antifibrotics (-0.3% w/ vs -6.2% w/o). 35% died, 4 lung transplants. 55% AEs, 46% D/C Rxhttps://t.co/s6O5uU3z2i

8. UKs MHRA issued a safety alert #MTX maybe associated w/ photosensitivity. Based on  Coroners death (by secondary infx) report assoc w/ photosensitivity Rxn in a MTX Rx pt. Warning is because this is not a well-known side effect https://bit.ly/4a1wRwz https://bit.ly/47NV8Ey

9. MTX Toxicity in Older CKD Patients

10. Rheum Fellowship Slots Fill Up for 2024