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Pre-exposure Prophylaxis for COVID-19 (4.22.22)

Apr 22, 2022 11:59 am

Dr. Jack Cush discusses the news and recent journal reports from last weeks, and answers viewer questions from #ACA - Ask Cush Anything.

  1. Open label, RCT compared triple DMARD Rx adding either LEF (MLH) or SSZ (MSH) to MTX+HCQ in 136 RA pts. Both were equally effective (non-inferior), 61.7% & 64.7% patients (p = 0.8) at wk 24. AE were also equal (15 vs 21 AE).
  2. Taiwan claims data shows among 2050 new SLE, 783 on HCQ. HCQ had no effect on future development of CKD over 14 yrs. Yet some rec HCQ in all lupus nephritis to reduce kidney flares, ESKD and death.
  3. UK drug safety warning, observational data 2700 pregnancies, 1st trimester pregabalin (Lyrica) use was assoc w/ higher rate of congenital malformations (5.9 vs 4.1%). US PI label says Lyrica use in Pregnancy "May cause fetal harm".
  4. Beijing #RA Cohort study compared 102 T2T (CENTRA) vs 271 usual care pt (TARRA) groups for SDAI outcomes at 12 mos. CENTRA had signif lower SDAI than TARRA (2.1 vs 3.4; p<0.001) & more SDAI-defined remission (71% vs 49%; p<0.001)
  5. ABP 654 is a Ustekinumab (anti-IL-12/23) biosimilar from Amgen - 563 pt, phase 3 trial shown to be equivalent to originator in mod- severe plaque psoriasis (no meaningful differences). ABP 654 is also being developed for Crohns & UC.
  6. Italian retrospective of Canakinumab in 80 kids w/ Systemic JIA - 12 moved from anakinra to CAN w/ iinactive dz/CID. 58 pts w/ active SoJIA started CAN - CID in 57% at 6mos, 64% 12 mos; MAS 3/100PY; Nonresp assoc w/ MAS, #Jts, Dz duration
  7. 2 studies from NKF meeting shows gout occurs in 13.5% of CKD on dialysis; and seen in 17-28% of Stg 3,4 CKD pts. CKD w/ Gout has more bone/mineral Dz (40 vs 26%), CHF (21 vs 14%), DJD (17 vs 9%); >1/3 NOT on urate lowering therapy
  8. Can IL-22 differentiate between IL-17 & TNF inhibitor #PSA responders? Pilot study 2 cohorts 81 PSA pts showed both biologics worked but somewhat better response in IL-17i Pts w/ low IL-22  & TNFi responses w/ high IL-22 levels.
  9. Administrative Claims data from British Columbia studied 100,358 OA pts and compared tramadol v NSAIDs. Tramadol was associated with higher All-cause mortality (HRs,1.2 to 1.5), more VTE (v diclofenac, HR 1.7), more hip Fx (HR 1.6)
  10. Dietary Improvement in Psoriatic Arthritis 
  11. TNR - Controversies in PsA 
  12. Evusheld as Protective Therapy in High Risk COVID-19 Patients (EDITORS NOTE: CORRECTION! Patients enrolled in this study were required to be COVID-19 test negative! I said they were positive but was wrong!)
  13. Ask Cush Anything: Listener questions/cases
    • Evusheld - who should get?
    • Refractory Behcet's
    • Plasmapheresis for SLE alveolar hemorrahge

The April 2022 Campaign "PsA All the Way" is sponsored by Janssen Pharmaceuticals

The author has received compensation as an advisor or consultant on this subject

Rheumatologists’ Comments

Jack Cush, MD

| Apr 23, 2022 4:07 pm

EDITORS CORRECTION: in the EVUSHELD Study - All the participants were required to have a negative point-of-care SARS-CoV-2 serologic test result at screening!

Saurav Suman

| Apr 24, 2022 4:16 pm

ACR 2020 Reproductive Health guidelines "conditionally recommend against" use of anakinra during pregnancy

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