Scleroderma – Thick and Thin (6.30.2023) Save

Dr. Jack Cush reviews the news, journal articles and regulatory decisions from the past week from RheumNow.com. This week focuses on parodoxical psoriasis, scleroderma outcomes and subsets, and alopecia areata therapy.

1. FDA has approved a 2nd JAK inhibitor for Alopecia areata - Pfizers Ritlecitinib (Litfulo) is approved for Adults and Adolescents (>12 yrs) With Severe Alopecia Areata (based on ALLEGRO trial, pub in Lancet) https://t.co/VmjhQOnZyS

2. Metanalysis of JAK inhib in Alopecia Areata: 7 RCTs &1710 patients shows JAK inhibitors yielded > 50% hair regrowth (OR 5.28) or > 90% improvement (OR 8.15) vs PBO. Oral JAK inhibitors were better than topical (latter = PBO). https://t.co/J9kGh89aEi

3. FDA Delays Bimekizumab Decision, Again UCB, the maker of the IL-17 A/F inhibitor bimekizumab (BMK), has announced that the FDA decision on BMK use in adults with moderate to severe plaque psoriasis has been delayed until the 3rd quarter of 2023. https://t.co/u3wZp2xain

4. Mirikizumab, an anti-IL-23 MAb, shown to be effective in phase 2 trial in ulcerative colitis. 1281 Pts: mirikizumab > placebo group w/ remission at wk 12 (24% vs 13%, P<0.001) & after re-randomization & maintenance @wk 40l (50% vs 25%, P<0.001) https://t.co/9ZPsRCDhJc

5. Paradoxical Psoriasis in Kids Taking TNF Inhibitors A multicenter cohort study reported  pediatric patients receiving TNF inhibitor therapy complicated by psoriasis, regardless of treatment indication or the specific TNF inhibitor. https://t.co/f1KmICaGNF

6. Paradoxical PsO (PP) studied in 2867 RA & 5316 SpA pts. 136 (1.7%) had paradox. Rxn, median 12 mos post TNFi [pustular (60%) or palmoplantar (31%)]. 73% PP favorably switched to other TNFi 46% or non-TNFi 27%. RA PP took SSZ, HCQ, LEF; SpA PP more smokers https://t.co/iYM3EOdSSM

7. Belimumab in adult inflamm myositis (IIM)? Small study 15 IIM pts recv ≥ 5 doses of belimumab or placebo; Treatment success (TIS ≥ 40) was more common with BEL (55% vs 33%) as was defined improvement (DOI: 33% vs 17%); not signif, but interesting! https://t.co/CG9ClLHEW6

8. Taiwan claims data analysis of 1,830 scleroderma (SSc) pts & 27,981 controls showed increased incidence of SSc hospitalized w/ heart failure of 3.5%, 5.3%, & 9.7% (at 3, 5, 10 yrs). SSc patients had an increased risk of HF (adjusted HR 3.26) https://t.co/4WcHfiTJVF

9. Scary Outcomes with Systemic Sclerosis Sine Scleroderma

10. High BMI Increases Arthritis Risk 

11. TitAIN Study: Secukinumab Efficacy in Giant Cell Arteritis