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RheumNow Podcast - Rheumatic Patients with COVID (5.29.20)

May 29, 2020 10:19 am

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

  1. TNR Grand Rounds on "Cytokine Storm Syndromes" features a lecture and Q&A with Dr. Randy Cron - watch it here>> 
  2. UPI quotes Dr. Tony Fauci stating (about hydroxychloroquine) "The scientific data is really quite evident now about the lack of efficacy". Yesterday France and other countries have banned the use of HCQ to treat COVID.
  3. BTK inhib (fenbrutinib-FEN) effective in #RA. In a 12 wk RCT, 480 MTX-IR pts Rx either PBO, adalimumab or FEN (50 mg or 150 mg/d). ACR50 resp was PBO 15%; ADA 36%; FEN 50mg 18%, 150 qd 28%, 200 mg bid 35%. FEM NO effx on myeloid & B cell biomarkers.
  4. CORRONA registry compared Triple DMARD (MSH) to TNF/MTX Rx; MSH is infrequently used; Triple DMARD pts were older, longer Dz duration, less Dz activity, more CA & comorbidities. Comparatively MSH had more Discontinuations & less likely to get to LDAS
  5. Skin is often involved w/ ANCA+ vasculitis - 1184 AAV pt study shows skin involvement in 34% GPA; 28% MPA & 47% EGPA. Common are petechiae/purpura pruritus, urticaria, and maculopapular rash. AAV w/ skin Sxs have more systemic dz (GN, alveolar hemorrhage)
  6. Metanalysis of 15 studies & 552,019 pts with RA shows the risk of diabetes to be significantly reduced in RA patients on HCQ (HR 0.61), methotrexate (HR 0.81), TNFi (HR 0.63), but increased with glucocorticoids (HR 1.46 < 10 mg; HR 2.25 for > 10 mg)
  7. Gilead announced phase 2/3 trial results of their JAK1 inhibitor, filgotinib, showing 200 mg qd (not 100 mg qd) dose was effective in ulcerative colitis (SELECTION study) with higher remission rates at weeks 10 (vs PBO); at wk 28 both 100mg and 200mg were superior to PBO 
  8. Phase 3 baricitinib trials (2890 pts) there were 215 prior/occult HBV infection (HbcAb+) and 8 (3.7%) had a positive HBV DNA+ (≥29 IU/mL). Four met the definition of reactivation and 3 required antiviral therapy = check HBV serologies with JAK inhib use
  9. Boston and Wuhan Report Rheum COVID Patients at Risk for Respiratory Failure  
  10. Low Risk of COVID-19 Pneumonia in Rheumatic Patients   
  11. Hydroxychloroquine Improves Survival in Lupus
The author has received compensation as an advisor or consultant on this subject

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