RheumNow Podcast – JAK Inhibitor Warnings from the FDA Save

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

1. FORWARD prospective registry showed Obesity to be associated with a substantially higher risk of incident chronic opioid use (HR adj 1.74). Approximately 1 in 4 cases of incident strong opioid use can be attributable to obesity ((HRadj 2.11) https://bit.ly/3mXJ7Ir

2. Using inpatient hospital records of 1.9 million SLE pts, the mortality of hospitalized #SLE changed little from 2006-2016; mortality dropped from 2.2% to 1.5% - with most of this decline between 2006-2008 and no change since. Racial disparities seen. https://t.co/UUsJYFxQS4

3. Steroid (GC) discontinuation from the BeSt and IMPROVED trials shows that w/ GC d/c 40% of RA pts Flare and 50-60% restart GC. Similar outcomes w/ 2nd attempt at GC d/c. Lower DAS28 scores had better odds of GC D/C. https://t.co/PtbgONNMwW

4. Gout does occur with low SUA levels; Using data from ARIC, Framingham and CARDIA studies, the gout risk over 15 yrs was: SUA < 4 = 0.59% 4–4.49 = 1.28% 4.5–4.99 = 0.86% 5–5.49 = 0.94% 5.5–5.99 = 1.52% 6–6.49 = 2.91% 6.50–6.99 = 3.2% > 7.00 = 12.2% https://t.co/xm9iQrQT3U

5. Metanalysis of long-term steroid (GC) in PMR (24 studies) 77%, 51%, & 25% PMR pts still GC respectively 1, 2, & 5 yrs. 1st Yr pooled relapse rate =43%. Prolonged GC use/relapse moreso in Females, Hi ESR, periph arthritis, starting dose, tapering speed https://t.co/n0gGlik1hO

6. Lancet: 1276 Wuhan hosp COVID-19 pts studied at 6 & 12 mos. 68% & 49% had at least 1 COVID Sx at 6 & 12 mos. 12 mos sxs: SOB (30%), depression(26%), pain & mobility. Women had more fatigue/weak (OR 1.43), anx/depression (2·0), diffusion impairment (2·97) https://t.co/A8STTYiHq5 https://t.co/J4JoKFa00K

7. Octave study examined COVID-19 Vax Ab responses in 600 immunocompromised-IMC (Cancer, IMID) pts. Compared to normals, fewer IMC seroconverted @4 wks (89 vs 100%). 40% of IMC had a low Ab resp; 11% of IMC had zero Ab response  https://t.co/11VkeNKzvL

8. Not All Immunosuppression Alters Vaccine Immunogenicity

9. Gut microbiome strongly influences irAE's in advanced melanoma pts taking checkpoint blockade targeting CTLA-4 and PD-1. Signatures for Bacteroides intestinalis & Intestinibacter bartlettii more grade 3+ irAE by inducing IL-1B https://t.co/rEHknJ3TSC

10. JCI paper showing IgG fibromyalgia pts given to mice leads to passive transfer of FM symptoms leads to sensory hypersensitivity; increased sensitivity to noxious mechanical & cold stimulation, & nociceptive fibers in skin-nerve preparations.WHAT?  https://t.co/af24a9BzzW

11. TNF Inhibitor Induced IgA Vasculitis in IBD 

12. FDA: New Cardiac and Cancer Warnings for All JAK Inhibitors  

13. Back TALK