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RheumNow Podcast – Do More DMARDs Mean More Switching? (9.17.2021)

Sep 16, 2021 11:37 pm

Dr. Jack Cush reviews the news and journal reports and takes cases and questions from rheumatologists.

  1. Metanalysis of JAK inhibition (tofacitinib & ruxolitinib) in alopecia areata - 12 studies, 346 Pts, Rx success (using SALT50 resp) was 66%, not influenced by age, sex, subtype. Alopecia recurrence seen w/in 3 mos of JAK D/C (in74%) https://t.co/CBSy4Kci80

  2. Population study shows risk of H. Zoster in adults to be high among bDMARD and CTX, also increased w/ AZA and HCQ but not MTX SSZ or LEF users. Data from 254065, 1,826311 Pt-Yrs F/U, 6295 new DMARD users, 17024 incident HZ https://t.co/1TeOAWN9LB

  3. MMWR reports that during the COVID Delta variant era, Vaccination against COVID-19: - Reduces risk of COVID-19 infection 5X - Reduces risk of COVID-19 Hospitalization >10X - Reduces risk of COVID-19 DEATH 10X https://t.co/rMRY84xX5F

  4. Study of 265 students w/ a positive COVID-19 test looked at 378 close contacts. Infx rates w both persons masked -7.7%, but when unmasked-32.4% (aORs = 4.9) https://t.co/fYdH33JbWR

  5. Effect of Diet on COVID Outcomes

  6. Probenecid, an OAT3 inhibitor, has inhibitory effects on RNA viruses (influenza, RSV) & decreases ACE2 expression. May have utility in COVID-19 as it was shown to inhibit SARS-CoV-2 replication in animal modelshttps://t.co/MClSjpqpSa

  7. Mease and colleagues have catalogued the current practices assessed in the CORRONA registry, noting that increased DMARD switching and decreased time on a given therapy by US physicians. https://t.co/cIWZw6KsuI

  8. A retrospective study of systemic sclerosis patients shows that acute hospitalization and mortality were not uncommon and were often linked to SSc-related lung disease. #RheumNow https://t.co/s5wSlndTrt

  9. Cases and Questions (AKA Back Talk)

  •  “What treatment do you use after 2 years of teraparitide in a woman with a hx of OP, spiral fracture while on a bisphosphonate”? Forteo PI.

  • “Do you have any inside info on the vaccines for COVID-19 during pregnancy?” OCOG Statement 

  • “Status of the Tocilizumab Shortage”? Genentech Statement

  • “How would you treat polyarthritis in a renal transplant patient?”

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

Rheumatologists’ Comments

Gary Botstein

| Sep 18, 2021 6:43 pm

Jack, re new DMARDs and increased switching, I have often seen rheumatoids in good remission who have a "brief" flare which I can overcome with a short steroid taper (< 10 days), returning to excellent low disease activity for long periods. Before many options were available, this was a good strategy. Now, with many DMARD options, the ":flare" is more likely to result in a switch of DMARDs or MOA. This may misrepresent the value of the original DMARD and also remove that DMARD as a viable choice for future use- when a simple steroid taper may have resulted in greater longevity of the original DMARD.

Gary Botstein

| Sep 18, 2021 6:48 pm

Probenecid seems to have favorable benefits in animals re COVID. I don't know the effect of probenecid in animal models but we need to keep in mind that probenecid in humans may affect the pharmacokinetics of many drugs which may alter the apparent risk or benefit re Covid outcomes.

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