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RheumNow Podcast – Infection in ANCA-Associated Vasculitis (3.26.2021)

Mar 26, 2021 4:07 pm

Dr. Jack Cush reviews the news, FDA Denials and journal articles from the past week on

  1. Analysis of CPRD registry and 15,670 MTX treated pts (46,571 PYs) showed discontinuation for abnormal or severely abnormal labs was 42/1000PY and 6/1,000PY and half that after Yr 1 (22 & 2.84). D/C for severe labs was (1/169) Yr1 & 1 in 352 per year after

  2. Claims data analysis (MarketScan, Medicare, Optum) of 87,653 RA patients starting either TNF inhibitor or tofacitinib shows venous thromboembolism (VTE) is rare (<1 per 100) RA Rx with either. VTE risk was same for Tofa and TNFi (HR of 1.13 [0.77-1.65])

  3. Retrospective study of 162 ANCA-Assoc Vasculitis patients (63% GPA, 37% MPA) - risk of serious infx was 7.5 per 100Pt-Yrs & was higher with cyclophosphamide that RTX induction. Risks for SIE:plasmapheresis dialysis & high BVAS in 1st year

  4. Retrospective review of 46 Rituximab treated ANCA-Assoc Vasculitis pts from 2 clinics (Mexico City, Lund) shows 24% had 18 severe infections (11.5/100 PY) - 72% within the 1st year. RTX was only independent SIE risk factor. 4 pts died, all from infection.

  5. Biologic efficacy in 147 pts w/ eosinophilic granulomatosis with polyangiitis - compares RTX (63), mepolizumab (51) or omalizumab (31). Remission/partial rates were better in RTX (49%/24%) and MEPO (78%, 10%) vs OMA (15%/33%)

  6. Uveitis is uncommonly caused drugs - especially : bisphosphonates, immune checkpoint inhibitors and antiviral drugs.

  7. Adding RTX to leflunomide works but may at ACR50 level. 140 RA pts on LEF given RTX or PBO w/ ongoing LEF. Wk 16, RTX+LEF ACR50=32% (vs PBO 15%; P=0.02), but not wk 24 (27 vs 15%), yet ACR20 was signif. RTX had more SAEs (20 vs 2%)

  8. Early RA pts given steroids (GC) do Not have short or long term benefits from GCs. 180 ERA pts given compared to 294 who did not. 5 yr F/U showed no differences in DAS28-CRP, HAQ or pain between groups. Steroids were used more in seronegative RA.

  9. Using both glucocorticoids & PPI leads to additive risk of osteoporotic fractures - UK database studiedd 12351 RA pts - 1411 w/ OP Fx. Concomitant GCs + PPIs assoc w/ 1.6-fold risk of OP Fx (adj HR: 1.60) vs nonuse; more than 1.2-fold risk w/ either alone

  10. FDA Panel Rejects Tanezumab for Osteoarthritis 

  11. RECIPE Trial - Mycophenolate to Suppress Immunogenicity with Pegloticase in Gout 

  12. Safety of Paternal DMARD or Biologic Use

The author has no conflicts of interest to disclose related to this subject

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